The Role of Elective Para-aortic Lymph Node Irradiation in Patients with Locally Advanced Cervical Cancer

Yap, Mei Ling; Cuartero, Julie; Yan, Jing Jou; Pintilie, Melania; Fyles, Anthony; Levin, Wilfred; Manchul, L.; Milosevic, Michael

doi:10.1016/j.clon.2014.08.008

Cited by 29 publications

(35 citation statements)

References 24 publications

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“…Patients with loco-regionally advanced cervical cancer undergo pelvic radiation in most institutions. The decision for radiation of abdomen is currently based on the use of CT or MRI in most centers around the world [10, 25, 26]. …”

Section: Discussionmentioning

confidence: 99%

Utility of PET-CT to evaluate retroperitoneal lymph node metastasis in advanced cervical cancer: Results of ACRIN6671/GOG0233 trial

Atri

Zhang

Dehdashti³

et al. 2016

Gynecologic Oncology

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Objective To assess if FDG PET combined with diagnostic CT improves diagnostic CT accuracy to detect lymph node (LN) metastasis in advanced cervical cancer. Methods A prospective HIPAA compliant ACRIN/GOG multicenter trial was conducted. Patients underwent concurrent diagnostic contrast-enhanced CT (DCT) and PET and pelvic/abdominal lymphadenectomy. Seven independent blinded readers reviewed PET-DCT and DCT one-month apart. Reference standard was surgically removed LN pathology. Accuracy values were calculated at participant level, correlating abdominal (right and left para-aortic/common iliac) and pelvic (right and left external iliac/obturator) LN regions with pathology, respecting laterality.. Reader average sensitivities/specificities of PET-DCT vs. DCT were compared with generalized linear mixed models, and AUCs with Obuchowski’s method. Results One hundred fifty-three patients had PET-DCT and pathology. Forty-three of 153 patients had metastasis to abdominal LNs. Sample size calculation required review of the first 40 abdominal positive and 40 randomly selected abdominal negative studies. Patients were 24 to 74 years (48.9±10.6) old. Mean sensitivities of PET-DCT/DCT for detection of LN metastasis in abdomen were 0.50 (CI: 0.44, 0.56) and 0.42 (CI: 0.36, 0.48), (p=0.052) and in pelvis 0.83 (CI: 0.78, 0.87) and 0.79 (CI: 0.73, 0.83) (p=0.15). Corresponding specificities were 0.85 (CI: 0.80, 0.89) and 0.89 (CI: 0.84, 0.92) (p=0.21) and 0.63 (CI: 0.54, 0.70) and 0.62 (CI: 0.53, 0.69) (p=0.83). Mean AUC values were 0.70 (CI: 0.61, 0.79) and 0.68 (CI: 0.59, 0.77) (p=0.43) and 0.80 (CI: 0.71, 0.88) and 0.76 (CI: 0.67, 0.85) (p=0.21) respectively. Conclusion Addition of PET to DCT resulted in statistically borderline increase in sensitivity to detect LN metastasis in abdomen in advanced cervical cancer.

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Section: Discussionmentioning

confidence: 99%

Utility of PET-CT to evaluate retroperitoneal lymph node metastasis in advanced cervical cancer: Results of ACRIN6671/GOG0233 trial

Atri

Zhang

Dehdashti³

et al. 2016

Gynecologic Oncology

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“…Our findings suggest that such benefits may be limited. Yap et al [ 25 ] also reported, in their prospective study of 228 patients treated with CRT, that the addition of PALN irradiation was not associated with a significant difference in disease-free survival, OS, and the rate of PALN relapse. In their study, isolated PALN relapse rates after pelvic RT alone were 2.6%.…”

Section: Discussionmentioning

confidence: 99%

Details of recurrence sites after definitive radiation therapy for cervical cancer

et al. 2016

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ObjectiveThis is a retrospective study aimed at clarifying the details of recurrence patterns and sites in patients with cervical cancer treated with definitive radiation therapy (RT).MethodsData were analyzed from consecutive patients, admitted to the University of Tokyo Hospital (Tokyo, Japan) between 2001 and 2013, who had received definitive RT, with or without chemotherapy, for International Federation of Gynecology and Obstetrics stages IB–IVA cervical cancer.ResultsOne hundred and thirty-seven patients formed the patient cohort. The median follow-up period for surviving patients was 57.0 months. A complete response was achieved in 121 patients (88%). Of these, 36 (30%) developed a cancer recurrence during follow-up. The first sites of recurrence were located in intra-RT fields in nine, outside RT fields in 20, and both in seven patients. In the intra-RT field group, all patients showed a local recurrence, while no one experienced an isolated pelvic lymph node (PLN) recurrence. In the outside RT field group, the most frequent site of recurrence was lung (60%), and three-quarters of patients were free from intra-RT field recurrence until the last follow-up. Of the entire cohort, including 48 PLN-positive patients, only seven patients (5.1%) developed PLN persistence or recurrence, all in the common iliac, internal iliac, and/or obturator nodes, and all with another synchronous relapse.ConclusionLocal disease was a major type of intra-RT field recurrence, while PLN control was favorable even in initially PLN-positive patients. The predominance of outside RT field recurrence alone highlights issues concerning distant control, including the intensity enhancement of systematic therapy.

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“…However, OS and DFS were not significantly different between the two groups ( 34 ). In retrospective studies conducted by Yi et al ( 35 ), Oh et al ( 36 ), Park et al ( 37 ), and Yap et al ( 38 ), patients with cervical cancer did not benefit from prophylactic EFI. In the study by Park et al ( 37 ), 203 patients with LACC were included.…”

Section: Prophylactic Efi Combined With Concurrent Chemotherapymentioning

confidence: 90%

Prophylactic Extended-Field Irradiation in Patients With Cervical Cancer: A Literature Review

et al. 2020

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Currently, the standard radiation field for locally advanced cervical cancer patients without evidence of para-aortic lymph node (PALN) metastasis is the pelvis. Due to the low accuracy of imaging in the diagnosis of PALN metastasis and the high incidence of PALN failure after pelvic radiotherapy, prophylactic pelvic and para-aortic irradiation, also called extended-field irradiation (EFI), is performed for patients with cervical cancer. In the era of concurrent chemoradiotherapy, randomized controlled trials are limited, and whether patients with cervical cancer can benefit from prophylactic EFI is still controversial. With conformal or intensity-modulated radiation therapy, patients tolerate prophylactic EFI very well. The severe toxicities of prophylactic EFI are not significantly higher than those of pelvic radiotherapy. We recommend delivering prophylactic EFI to cervical cancer patients with common iliac lymph nodes metastasis. Clinical trials are needed to investigate whether patients with ≥3 positive pelvic lymph nodes and FIGO stage IIIB disease can benefit from prophylactic EFI. According to the distribution of PALNs, it is reasonable to use the renal vein as the upper border of the radiation therapy field for patients treated with prophylactic EFI. The clinical target volume expansion of the node from the vessel should be smaller in the right para-caval region than in the left lateral para-aortic region. The right para-caval region above L2 or L3 may be omitted from the PALN target volume to reduce the dose to the duodenum. More clinical trials on prophylactic EFI in cervical cancer are needed.

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The Role of Elective Para-aortic Lymph Node Irradiation in Patients with Locally Advanced Cervical Cancer

Cited by 29 publications

References 24 publications

Utility of PET-CT to evaluate retroperitoneal lymph node metastasis in advanced cervical cancer: Results of ACRIN6671/GOG0233 trial

Utility of PET-CT to evaluate retroperitoneal lymph node metastasis in advanced cervical cancer: Results of ACRIN6671/GOG0233 trial

Details of recurrence sites after definitive radiation therapy for cervical cancer

Prophylactic Extended-Field Irradiation in Patients With Cervical Cancer: A Literature Review

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