Impact of nodal boost irradiation and MR-based brachytherapy on oncologic outcomes in node-positive cervical cancer

Tiwari, Richa; Narayanan, Geeta S; Reddy, Vaishnavi Perumal; Vishwanathan, Bhaskar; Narayanan, Sowmya; Venugopal, Ramya

doi:10.1016/j.ygyno.2021.07.023

Cited by 6 publications

(6 citation statements)

References 24 publications

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“…SIB achieved high rates of locoregional control, which is consistent with Tiwari et al prospective study showing regional control rates of 93% in nodal boost group versus 80% in the absence of boost. In their study, no significant difference were found in terms of Disease Free Survival (DFS) and OS, but 60% of nodal group patients underwent a sequential boost and only 40% a SIB (11). This choice could explain why most studies didn't showed significant benefits of nodal dose escalation in terms of distant or overall survival.…”

Section: Discussionmentioning

confidence: 96%

Simultaneous integrated boost on pathologic lymph nodes safely improves clinical outcomes compared to sequential boost in locally advanced cervical cancer: a multicenter retrospective study

Guigo,

Dauda,

Lequesne

et al. 2024

Front. Oncol.

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BackgroundObjectiveThis multicenter study aimed to retrospectively evaluate the impact of high boost simultaneous integrated boost (SIB) to pathologic lymph nodes compared to Sequential boost (Seq) in patients with locally advanced cervical cancer (LACC).Materials and methods97 patients with pelvic and/or para-aortic (PAo) node-positive LACC treated by definitive chemoradiation were included. Two groups were analyzed: Sequential boost group and simultaneous integrated boost (SIB) group. Endpoints were Distant Recurrence Free Survival (DRFS), Recurrence Free Survival (RFS), Overall Survival (OS), locoregional pelvic and PAo control and toxicities.Results3-years DRFS in SIB and Seq groups was 65% and 31% respectively (log-rank p < 0.001). 3-years RFS was 58% and 26% respectively (log-rank p = 0.009). DRFS prognostic factors in multivariable analysis were SIB, PAo involvement and maximum pelvic node diameter ≥ 2cm. Adenocarcinoma histology and absence of brachytherapy tended to be prognostic factors. SIB provided the best pelvic control at first imaging with 97%. There was no significant difference in terms of toxicities between groups.ConclusionsNodal SIB seems to be unavoidable in the treatment of node-positive LACC. It provides the best DRFS, RFS and pelvic control without additional toxicity, with a shortened treatment duration.

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Section: Discussionmentioning

confidence: 96%

Simultaneous integrated boost on pathologic lymph nodes safely improves clinical outcomes compared to sequential boost in locally advanced cervical cancer: a multicenter retrospective study

Guigo,

Dauda,

Lequesne

et al. 2024

Front. Oncol.

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“…Furthermore, in our study, we used simultaneous integrated boost (SIB) for pathologic nodes to 60 Gy EQD2 during EBRT. A study by Richa Tiwari et al (2021) showed the significant improvement of the 3-year regional control in patients with node-positive cervical cancer treated with nodal boost irradiation and MRI-based brachytherapy compared to the non-boost arm (93% vs. 80%, p = 0.035) [25].…”

Section: Discussionmentioning

confidence: 99%

Outcome and toxicity of chemoradiation using volumetric modulated arc therapy followed by 3D image-guided brachytherapy for cervical cancer: Vietnam National Cancer Hospital experience

Van Anh,

Thang,

Dung

et al. 2024

Rep Pract Oncol Radiother.

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Background Volumetric modulated arc therapy (VMAT) and 3D image-guided brachytherapy (3D-IGBT) have recently been introduced in Vietnam for the treatment of locally advanced cervical cancer. This study aims to assess the outcomes and toxicities of chemoradiation using VMAT followed by 3D-IGBT in Vietnamese cervical cancer patients. Materials and methods A prospective interventional study on 72 patients with 2018 International Federation of Gynecology and Obstetrics (FIGO) stage IB3–IIIC2 disease who underwent concurrent chemoradiation using VMAT, followed by 3D-IGBT according to EMBRACE-II protocol. Primary endpoints were locoregional control; secondary endpoints were systemic control and toxicity. Results Median body volume received 43 Gy was 1589.1 cm 3 (range 1214.8–2574.8). Median high-risk clinical target volume (CTV-HR) was 18.8 cm 3 (range 8.6–61.2) with a median dose to 90% (D90) of CTV-HR of 90.6 Gy (range 86.8–99.6). Mean doses to 2cc (D2cc) of bladder, rectum, and sigmoid were 75.8, 55.2, and 62.1 Gy, respectively. At median 19-month follow-up (range 12–25), locoregional control and systemic control were 95.8% and 81.9%, respectively. Systemic control was the lowest in N2 disease (54.5%). Grade ≥ 3 acute toxicities were less than 10%, except neutropenia (31.9%). Extended-field radiation increased significantly nausea, fatigue, and thrombocytopenia. No grade ≥ 3 proctitis or cystitis; 8.3% had grade 3 vaginal stenosis. Conclusions VMAT-based chemoradiation therapy followed by 3D-IGBT achieved high locoregional control with manageable toxicities in locally advanced cervical cancer. Systemic control correlated with disease stage.

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“…With the paradigm shift towards MR-based IGABT in the past decade achieving excellent local control, there is a pressing demand to address regional and systemic disease control, especially in patients with node-positive disease [ 10 ]. One of the attractive strategies is dose escalation to involved nodes, which has demonstrated encouraging outcomes [ 18 , 35 , 36 , 37 ]. However, the dose–response relationship for nodal control has not been clearly defined, thus consensus on the optimal dose prescription is lacking.…”

Section: Discussionmentioning

confidence: 99%

“…From retrospective series, it was also suggested that the dose–response relationship of involved nodes appears to be flat at 55 Gy to 60 Gy, thus the benefit of further escalation to above 60 Gy EQD2 is doubtful [ 28 ]. Among the limited evidence for nodal SIB in the context of chemoradiotherapy with IGABT, effective nodal control of 83% to 100% using median nodal doses of 55 Gy to 57.5 Gy has been reported [ 18 , 35 , 37 ]. It is noteworthy that for many of these studies, the overall regional nodal control was reported instead of the tumoricidal effect of SIB on individual nodes.…”

Section: Discussionmentioning

confidence: 99%

“…From the prior literature, the control of involved nodes is adversely influenced by factors such as nodal volume (e.g., greater than 3 cm 3 ), size larger than 2 cm, and prescription dose of less than 58 Gy in EQD2 10 [ 35 , 38 ]. Another study reported a significant correlation between SUVmax and treatment failure in boosted nodes, and thus, intensification of treatment of nodes with a high SUVmax has been suggested [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

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Simultaneous Integrated Boost for Dose Escalation in Node-Positive Cervical Cancer: 5-Year Experience in a Single Institution

Cheung,

Law,

Fung

et al. 2023

Cancers

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This study retrospectively evaluates clinical outcomes of dose escalation to involved nodes using volumetric modulated arc therapy (VMAT) with simultaneous integrated boost (SIB) for node-positive locally advanced cervical cancer (LACC) at a single institution. Consecutive patients with node-positive LACC (FIGO2018 IIIC1-IVA) who received definitive chemoradiotherapy by VMAT 45 Gy in 25 fractions with SIB to 55–57.5 Gy, followed by magnetic resonance image-guided adaptive brachytherapy (IGABT) between 2018 and 2022 were identified. A standardized strategy regarding nodal boost delivery and elective para-aortic (PAO) irradiation was employed. Primary endpoints were involved nodal control (INC) and regional nodal control (RNC). Secondary endpoints were pelvic control (PC), locoregional control (LRC), disease-free survival (DFS), overall survival (OS), failure pattern, and radiotherapy-related toxicities. A total of 234 involved nodes (182 pelvic and 52 PAO) in 54 patients, with a median of 3 involved nodes per patient (range 1–16), were analyzed. After a median follow-up of 19.6 months, excellent INC was achieved, with four (2%) boost-volume failures occurring in three patients. The 2-year actuarial RNC, PC, LRC, DFS, and OS were 93%, 87%, 87%, 78%, and 85%, respectively. Adenocarcinoma histology was associated with worse RNC (p = 0.02) and OS (p = 0.04), whereas the primary tumor maximum standardized uptake value (SUVmax) was associated with worse PC (p = 0.04) and LRC (p = 0.046) on univariate analysis. The incidence of grade ≥3 acute and late radiotherapy-related toxicity were 2% and 4%, respectively. Treatment of node-positive LACC with VMAT with SIB allows safe and effective dose escalation. The 5-year local experience demonstrated excellent treatment outcomes without additional toxicity.

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Impact of nodal boost irradiation and MR-based brachytherapy on oncologic outcomes in node-positive cervical cancer

Cited by 6 publications

References 24 publications

Simultaneous integrated boost on pathologic lymph nodes safely improves clinical outcomes compared to sequential boost in locally advanced cervical cancer: a multicenter retrospective study

Simultaneous integrated boost on pathologic lymph nodes safely improves clinical outcomes compared to sequential boost in locally advanced cervical cancer: a multicenter retrospective study

Outcome and toxicity of chemoradiation using volumetric modulated arc therapy followed by 3D image-guided brachytherapy for cervical cancer: Vietnam National Cancer Hospital experience

Simultaneous Integrated Boost for Dose Escalation in Node-Positive Cervical Cancer: 5-Year Experience in a Single Institution

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