Low-Dose, Prophylactic, Extended-Field, Intensity-Modulated Radiotherapy Plus Concurrent Weekly Cisplatin for Patients With Stage IB2-IIIB Cervical Cancer, Positive Pelvic Lymph Nodes, and Negative Para-aortic Lymph Nodes

Liang, Ji An; Chen, Shang-Wen; Hung, Yao Ching; Yeh, Lian Shung; Chang, Wei Chun; Lin, Wen‐Chuan; Chang, Yin Yi

doi:10.1097/igc.0b013e31829f4dc5

Cited by 39 publications

(29 citation statements)

References 23 publications

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“…Our cohort included patients with and without pelvic lymph node metastases, similar to the previous randomised trials [7,15]. One study [20] treated patients with positive pelvic nodes using intensity-modulated PART and showed better 3 year DFS compared with historical controls. However, there was a small sample size and historical controls differed to the study patients in terms of use of PET/computed tomography imaging and median follow-up.…”

Section: Discussionmentioning

confidence: 91%

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

et al. 2014

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Section: Discussionmentioning

confidence: 91%

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

et al. 2014

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“…In a prospective study evaluating extended field IMRT with concurrent cisplatin in 32 patients with stage IB2–IIIB cervical cancer with positive PLNs and negative PALNs, acute grade ≥3 gastrointestinal, genitourinary, and hematologic toxicities occurred in 2 (6.3%), 1 (3.1%), and 18 (56.3%) patients, respectively. [21] One (3.1%) patient had a late grade 3 gastrointestinal complication, and 1 (3.1%) experienced genitourinary toxicity. The 3-year actuarial OS, DFS, and DMFS rates were 87%, 82%, and 79%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of semiextended field intensity-modulated radiation therapy and concurrent cisplatin in locally advanced cervical cancer patients

et al. 2017

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Patients with locally advanced cervical cancer (LACC) are at risk of para-aortic lymph node (PALN) metastasis. Pelvic concurrent chemoradiotherapy, the current standard treatment for LACC, has a PALN failure rate of 9% according to the Radiation Therapy Oncology Group Trial 90–01, suggesting that it may not completely eliminate all microscopic tumors in the PALNs. To minimize the toxicities associated with conventional prophylactic extended-field radiotherapy, our institute use prophylactic semiextended field radiotherapy that includes only the PALNs below the level of the renal vessels. Use of intensity-modulated radiotherapy (IMRT) is another means of reducing the incidence of toxicity. This study evaluated the safety and efficacy of prophylactic semiextended field IMRT (SEF-IMRT) and concurrent cisplatin chemotherapy in patients with LACC.We retrospectively assessed survival and toxicity in 76 patients with stage IB2–IVA cervical cancer and negative PALNs who received prophylactic SEF-IMRT and concurrent weekly cisplatin (40 mg/m2) between 2004 and 2013. The region targeted by SEF-IMRT included the PALNs below the level of the renal vessels, and the prescribed dose was 50.4 Gy in 28 fractions. Brachytherapy was administered at a dose of 30 Gy in 6 fractions. Survival outcomes were calculated by using the Kaplan–Meier method, and acute and late toxicities were scored according to the Common Terminology Criteria for Adverse Events, version 3.0.All patients completed the planned SEF-IMRT, as well as brachytherapy. Acute grade ≥3 gastrointestinal, genitourinary, and hematologic toxicities were observed in 2, 0, and 41 patients, respectively. The median follow-up time after SEF-IMRT was 55 (range, 11–124) months. Eight patients developed out-field distant recurrences without PALN failure, and 1 patient experienced out-field PALN failure with simultaneous distant metastasis. No patients had late genitourinary toxicities, and 3 patients had late grade 3 gastrointestinal toxicities. The 5-year overall survival, disease-free survival, local failure-free survival, regional failure-free survival, PALN failure-free survival, and distant metastasis-free survival rates were 85.0%, 84.4%, 96.0%, 97.3%, 98.6%, and 88.4%, respectively.For patients with LACC, prophylactic PALN irradiation up to the level of the renal vessels reduced PALN recurrence and resulted in favorable outcomes with few severe toxicities.

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“…Three non-randomized prospective studies support primary use of IMRT for cervical cancer [444546]. Toxicity has been reduced with similar survival outcomes.…”

Section: Clinical Considerations and Recommendationsmentioning

confidence: 99%

Practice guidelines for management of cervical cancer in Korea: a Korean Society of Gynecologic Oncology Consensus Statement

et al. 2017

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Clinical practice guidelines for gynecologic cancers have been developed by academic society from several countries. Each guideline reflected their own insurance system and unique medical environment, based on the published evidence. The Korean Society of Gynecologic Oncology (KSGO) published the first edition of practice guidelines for gynecologic cancer treatment in late 2006; the second edition was released in July 2010 as an evidence-based recommendation. The Guidelines Revision Committee was established in 2015 and decided to develop the third edition of the guidelines in an advanced format based on evidence-based medicine, embracing up-to-date clinical trials and qualified Korean data. These guidelines cover strategies for diagnosis and treatment of primary and recurrent cervical cancer. The committee members and many gynecologic oncologists derived key questions through discussions, and a number of relevant scientific literature were reviewed in advance. Recommendations for each specific question were developed by the consensus conference, and they are summarized here, along with the details. The objective of these practice guidelines is to establish standard policies on issues in clinical practice related to the management in cervical cancer based on the results in published papers to date and the consensus of experts as a KSGO Consensus Statement.

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Low-Dose, Prophylactic, Extended-Field, Intensity-Modulated Radiotherapy Plus Concurrent Weekly Cisplatin for Patients With Stage IB2-IIIB Cervical Cancer, Positive Pelvic Lymph Nodes, and Negative Para-aortic Lymph Nodes

Abstract: Extended-field IMRT of 40 Gy to the PALN plus concurrent cisplatin can effectively eradicate subclinical disease at the PALN and improve the outcome for patients with PLN-positive stage IB2-IIIB cervical cancer.

Cited by 39 publications

References 23 publications

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

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

Safety and efficacy of semiextended field intensity-modulated radiation therapy and concurrent cisplatin in locally advanced cervical cancer patients

Practice guidelines for management of cervical cancer in Korea: a Korean Society of Gynecologic Oncology Consensus Statement

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