Cancer Res Treat.  2014 Oct;46(4):374-382. 10.4143/crt.2013.084.

Is Prophylactic Irradiation to Para-aortic Lymph Nodes in Locally Advanced Cervical Cancer Necessary?

Affiliations
  • 1Department of Radiation Oncology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea. jhkim@dsmc.or.kr
  • 2Department of Obstetrics and Gynecology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.

Abstract

PURPOSE
This study evaluated the efficacy of extended field irradiation (EFI) in patients with locally advanced cervical cancer without para-aortic nodal involvement.
MATERIALS AND METHODS
A total of 203 patients with locally advanced cervical cancer (International Federation of Gynecology and Obstetrics [FIGO] stage, IB2-IIIB) treated with radiotherapy at Keimyung University Dongsan Medical Center from 1996 to 2010 were retrospectively analyzed. The median patient age was 59 years (range, 29 to 83 years). None of the patients had para-aortic node metastases. Of the 203 patients, 88 underwent EFI and 115 underwent irradiation of the pelvis only. Concurrent chemoradiotherapy (CCRT) was administered to 133 patients. EFI field was used for treatment of 26 patients who received radiotherapy alone and 62 who received CCRT.
RESULTS
The median follow-up period was 60 months. The 2- and 5-year overall survival (OS) rates were 87.8% and 73.5%, respectively, and the 2- and 5-year disease-free survival rates were 81.7% and 75.0%, respectively, however, no survival differences were observed between the two treatment field groups. EFI tended to increase OS in the radiotherapy alone group, but not in the CCRT group.
CONCLUSION
These findings suggest that EFI does not have a significant effect in patients with locally advanced cervical cancer, especially in patients receiving CCRT. Conduct of additional studies will be required in order to confirm these findings.

Keyword

Uterine cervical neoplasms; Radiotherapy; Survival rate; Lymph nodes; Neoplasm metastasis

MeSH Terms

Chemoradiotherapy
Disease-Free Survival
Follow-Up Studies
Gynecology
Humans
Lymph Nodes*
Neoplasm Metastasis
Obstetrics
Pelvis
Radiotherapy
Retrospective Studies
Survival Rate
Uterine Cervical Neoplasms*

Figure

  • Fig. 1. Overall survival curves according to treatment field. EFI, extended field irradiation.

  • Fig. 2. Overall survival curves according to treatment field in patients treated with radiotherapy alone. EFI, extended field irradiation.

  • Fig. 3. Overall survival curves according to treatment field in patients treated with radiotherapy alone. EFI, extended field irradiation.

  • Fig. 4. Overall survival curves according to four different treatment modalities. EFI, extended field irradiation; CCRT, concurrent chemoradiotherapy.


Reference

References

1. Berman ML, Keys H, Creasman W, DiSaia P, Bundy B, Blessing J. Survival and patterns of recurrence in cervical cancer metastatic to periaortic lymph nodes (a Gynecologic Oncology Group study). Gynecol Oncol. 1984; 19:8–16.
Article
2. Ring KL, Young JL, Dunlap NE, Andersen WA, Schneider BF. Extended-field radiation therapy with whole pelvis radiotherapy and cisplatin chemosensitization in the treatment of IB2-IIIB cervical carcinoma: a retrospective review. Am J Obstet Gynecol. 2009; 201:109.e1-6.
Article
3. Rotman M, Pajak TF, Choi K, Clery M, Marcial V, Grigsby PW, et al. Prophylactic extended-field irradiation of para-aortic lymph nodes in stages IIB and bulky IB and IIA cervical carcinomas. Ten-year treatment results of RTOG 79-20. JAMA. 1995; 274:387–93.
Article
4. Haie C, Pejovic MH, Gerbaulet A, Horiot JC, Pourquier H, Delouche J, et al. Is prophylactic para-aortic irradiation worthwhile in the treatment of advanced cervical carcinoma? Results of a controlled clinical trial of the EORTC radiotherapy group. Radiother Oncol. 1988; 11:101–12.
Article
5. Chatani M, Matayoshi Y, Masaki N, Narumi Y, Teshima T, Inoue T. Prophylactic irradiation of para-aortic lymph nodes in carcinoma of the uterine cervix: a prospective randomized study. Strahlenther Onkol. 1995; 171:655–60.
6. Sood BM, Gorla GR, Garg M, Anderson PS, Fields AL, Runowicz CD, et al. Extended-field radiotherapy and high-dose-rate brachytherapy in carcinoma of the uterine cervix: clinical experience with and without concomitant chemotherapy. Cancer. 2003; 97:1781–8.
7. Morris M, Eifel PJ, Lu J, Grigsby PW, Levenback C, Stevens RE, et al. Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer. N Engl J Med. 1999; 340:1137–43.
Article
8. Eifel PJ, Winter K, Morris M, Levenback C, Grigsby PW, Cooper J, et al. Pelvic irradiation with concurrent chemotherapy versus pelvic and para-aortic irradiation for high-risk cervical cancer: an update of radiation therapy oncology group trial (RTOG) 90-01. J Clin Oncol. 2004; 22:872–80.
Article
9. Thomas G, Dembo A, Fyles A, Gadalla T, Beale F, Bean H, et al. Concurrent chemoradiation in advanced cervical cancer. Gynecol Oncol. 1990; 38:446–51.
Article
10. Grigsby PW, Graham MV, Perez CA, Galakatos AE, Camel HM, Kao MS. Prospective phase I/II studies of definitive irradiation and chemotherapy for advanced gynecologic malignancies. Am J Clin Oncol. 1996; 19:1–6.
Article
11. Malfetano JH, Keys H, Cunningham MJ, Gibbons S, Ambros R. Extended field radiation and cisplatin for stage IIB and IIIB cervical carcinoma. Gynecol Oncol. 1997; 67:203–7.
Article
12. Chung YL, Jian JJ, Cheng SH, Hsieh CI, Tan TD, Chang HJ, et al. Extended-field radiotherapy and high-dose-rate brachytherapy with concurrent and adjuvant cisplatin-based chemotherapy for locally advanced cervical cancer: a phase I/II study. Gynecol Oncol. 2005; 97:126–35.
Article
13. Uno T, Mitsuhashi A, Isobe K, Yamamoto S, Kawakami H, Ueno N, et al. Concurrent daily cisplatin and extended-field radiation therapy for carcinoma of the cervix. Int J Gynecol Cancer. 2008; 18:80–4.
Article
14. Pecorelli S, Zigliani L, Odicino F. Revised FIGO staging for carcinoma of the cervix. Int J Gynaecol Obstet. 2009; 105:107–8.
Article
15. Akin O, Mironov S, Pandit-Taskar N, Hann LE. Imaging of uterine cancer. Radiol Clin North Am. 2007; 45:167–82.
Article
16. Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982; 5:649–55.
Article
17. Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009; 45:228–47.
Article
18. Rose PG, Bundy BN, Watkins EB, Thigpen JT, Deppe G, Maiman MA, et al. Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med. 1999; 340:1144–53.
Article
19. Keys HM, Bundy BN, Stehman FB, Muderspach LI, Chafe WE, Suggs CL 3rd, et al. Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med. 1999; 340:1154–61.
Article
20. Whitney CW, Sause W, Bundy BN, Malfetano JH, Hannigan EV, Fowler WC Jr, et al. Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage IIB-IVA carcinoma of the cervix with negative para-aortic lymph nodes: a Gynecologic Oncology Group and Southwest Oncology Group study. J Clin Oncol. 1999; 17:1339–48.
Article
21. Peters WA 3rd, Liu PY, Barrett RJ 2nd, Stock RJ, Monk BJ, Berek JS, et al. Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol. 2000; 18:1606–13.
Article
22. Green JA, Kirwan JM, Tierney JF, Symonds P, Fresco L, Collingwood M, et al. Survival and recurrence after concomitant chemotherapy and radiotherapy for cancer of the uterine cervix: a systematic review and meta-analysis. Lancet. 2001; 358:781–6.
Article
23. Varia MA, Bundy BN, Deppe G, Mannel R, Averette HE, Rose PG, et al. Cervical carcinoma metastatic to para-aortic nodes: extended field radiation therapy with concomitant 5-fluorouracil and cisplatin chemotherapy: a Gynecologic Oncology Group study. Int J Radiat Oncol Biol Phys. 1998; 42:1015–23.
Article
24. Fu KK. Biological basis for the interaction of chemotherapeutic agents and radiation therapy. Cancer. 1985; 55(9 Suppl):2123–30.
Article
25. Papadimitriou CA, Sarris K, Moulopoulos LA, Fountzilas G, Anagnostopoulos A, Voulgaris Z, et al. Phase II trial of paclitaxel and cisplatin in metastatic and recurrent carcinoma of the uterine cervix. J Clin Oncol. 1999; 17:761–6.
Article
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