Multi-institutional Observational Study of Prophylactic Extended-Field Concurrent Chemoradiation Therapy Using Weekly Cisplatin for Patients With Pelvic Node-Positive Cervical Cancer in East and Southeast Asia

Wakatsuki, Masaru; Kato, Shingo; Ohno, Tatsuya; Banu, Parvin; Hoang, Nguyen Cong; Yadamsuren, Erdenetuya; Supriana, Nana; Cao, Jianping; Devi, C.R. Beena; Calaguas, M.J.; Chansilpa, Yaowalak; Cho, Chul-Koo; Адылханов, Т А; Okonogi, Noriyuki; Nakano, Takashi; Tsujii, Hirohiko

doi:10.1016/j.ijrobp.2019.04.039

Cited by 11 publications

(5 citation statements)

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“…Although several studies have investigated the efficacy of prophylactic para-aortic irradiation for advanced stage cervical cancer [ 26 – 31 ], the value of prophylactic para-aortic irradiation remains controversial. Some studies claimed that prophylactic para-aortic irradiation improves survival and reduces the risk of recurrence [ 26 – 28 ], whereas the results from other studies supported contrary claims: prophylactic para-aortic irradiation does not reduce the risk of recurrence for patients with advanced-stage cervical carcinoma [ 29 – 31 ]. No randomized controlled study has explored the value of prophylactic para-aortic irradiation for treating ASC.…”

Section: Discussionmentioning

confidence: 99%

The best postoperative adjuvant therapy for patients with early stage cervical adenosquamous carcinoma

Liu

Zhang

et al. 2022

BMC Women's Health

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Background Cervical adenosquamous carcinoma (ASC) was previously thought to be a subtype of cervical adenocarcinoma, but recent studies have found that the clinical features of the two diseases are different. Moreover, the pathological characteristics, survival, prognosis, and optimal ASC therapy remain unknown. This study aims to retrospectively analyze the postoperative survival of patients with early-stage ASC and to evaluate their condition after treatment with postoperative concurrent chemoradiotherapy (CCRT) and prophylactic irradiation of the para-aortic lymphatic drainage area. Methods This study enrolled 131 patients with pathologically confirmed ASC screened from 3502 patients with confirmed stage I–II cervical cancer diagnosis who had completed surgical treatments in our hospital. Among the 131 enrolled patients, 75 patients received CCRT, 33 patients received chemotherapy (CT), and 23 patients did not receive adjuvant treatment (named surgery alone (S alone). Of the 75 patients CCRT, 43 patients received prophylactic irradiation of the para-aortic lymphatic drainage area. The efficacy of the postoperative treatments of patients among groups (CCRT, CT, and S alone) was compared. Results The median follow-up time, age, and overall survival (OS) were 76 months, 43 years, and 74 months, respectively. The 3- and 5-year survival rates were 82% and 71.4%, respectively. The median disease-free survival (DFS) was 64 months. Cox regression analysis showed that postoperative adjuvant treatment modalities and positive lymph node metastases were associated with OS and DFS. Patients who received CCRT treatment had higher OS and DFS than those with CT and S alone. Prophylactic irradiation of the para-aortic lymphatic drainage area did not improve the OS and DFS of patients with CCRT treatment. However, further subgroup analysis suggested that it might improve survival rates in patients who had positive pelvic lymph nodes as confirmed by postoperative pathology. Conclusion Postoperative CCRT improved the survival rates in patients with early-stage ASC. The value of prophylactic irradiation of the para-aortic lymphatic drainage area remains debatable, but it may benefit patients with pelvic lymph node involvement.

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Section: Discussionmentioning

confidence: 99%

The best postoperative adjuvant therapy for patients with early stage cervical adenosquamous carcinoma

Liu

Zhang

et al. 2022

BMC Women's Health

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“…Acute grade 3 leukopenia was observed in 20 patients (21%), and late grade 3 gastrointestinal toxicity was observed in 3%. The results showed that the delayed prophylactic paraaortic radiotherapy decreased the rate of distant metastases and improved PFS and OS rates, without increasing toxicity [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Observation of Prophylactic Extended-Field Intensity-Modulated Radiation Therapy with Synchronous Chemotherapy in Locally Advanced Cervical Cancer

et al. 2021

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Background We aimed to evaluate the value of prophylactic extended-field intensity-modulated radiation therapy (IMRT) in the treatment of locally advanced cervical cancer with multiple pelvic lymph node metastases (≥2) and negative common iliac and paraaortic lymph nodes. Material/Methods Thirty-four patient with newly diagnosed cervical cancer (IB1-IVA) and multiple pelvic lymph node metastases (≥2) confirmed by computed tomography and magnetic resonance imaging were randomly divided into an extended-field group (17 patients) and a pelvic-field group (17 patients). In the extended-field group, we added the drainage area of paraaortic lymph nodes on the pelvic field. The pelvic field was administered Dt 45.0 to 50.4 Gy, while the drainage area of paraaortic lymph nodes was administered Dt 40.0 to 45.0 Gy. Both groups were given Ir I92 intracavitary radiotherapy after 3 weeks of external irradiation. The total dose of point A was 25.0 to 30.0 Gy, fractional 6.0 to 7.0 Gy. All patients had concurrent platinum-based chemotherapy once weekly until the end of radiotherapy. Results No paraaortic lymph node metastasis was found in the extended-field group ( P =0.0184), and disease-free survival (DFS) was prolonged ( P =0.0286). Adverse effects in patients with III–IV degree myelosuppression were increased in the extended-field group ( P =0.0324). However, all patients recovered after symptomatic treatment. Conclusions Prophylactic extended-field IMRT with chemotherapy reduced the metastasis rate of paraaortic lymph nodes and prolonged the DFS in patients with locally advanced cervical cancer and multiple pelvic lymph node metastases (≥2), while the toxic adverse effects were tolerated.

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“…On the contrast, some studies indicated that prophylactic EFI did not reduce the risk of para‐aortic nodal recurrence and confer survival benefits in patients with positive pelvic lymph node cervical cancer 10,11 . Anyway, prophylactic EFI is considered to be safe in modern radiotherapy techniques without a significant increase in severe toxicities in patients with cervical cancer 11–13 …”

Section: Introductionmentioning

confidence: 99%

“… 10 , 11 Anyway, prophylactic EFI is considered to be safe in modern radiotherapy techniques without a significant increase in severe toxicities in patients with cervical cancer. 11 , 12 , 13 …”

Section: Introductionmentioning

confidence: 99%

A modified delineation method of para‐aortic nodal clinical target volume in patients with locally advanced cervical cancer

Wang

Liu

et al. 2021

Cancer Medicine

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Purpose To validate the nodal center coverage (NCC) of the three mainstream delineation methods of para‐aortic nodal clinical target volume (CTV) and propose a modified delineation method of para‐aortic nodal CTV in prophylactic extended‐field irradiation (EFI) of cervical cancer. Methods A total of 106 patients with para‐aortic lymph nodes (PALNs) identified on PET/CT were included at Peking Union Medical College Hospital between 2011 and 2020. PALNs were classified as left lateral para‐aortic (LLPA), aorto‐caval (AC), and right para‐caval (RPC). Distances from the nodal center to the aorta and inferior vena cava (IVC) were measured. The NCC of the three mainstream delineation methods of para‐aortic nodal CTV (CTV‐K, CTV‐S, and CTV‐D) and a modified CTV (CTV‐M) was calculated. Radiotherapy plans were created based on 4 CTVs for 10 selected patients who received prophylactic EFI. The chi‐squared test and the Student's t‐test were performed. Results We identified 344 PALNs (216 LLPA, 101 AC, and 27 RPC) in 106 patients. Mean distance from the nodal center to the aorta was 9.6 mm in the LLPA and 7 mm in the AC and from the nodal center to the IVC was 5.6 mm in the AC and 5.6 mm in the RPC. CTV‐D improved the NCC of 98% compared with 92% for CTV‐K (p = 0.002) and 95% for CTV‐S (p = 0.046). CTV‐M provided the same satisfactory NCC as CTV‐D (97% vs. 98%, p = 0.485). The V50Gy to the duodenum, the Dmean to the bilateral kidneys, and the V45Gy to the small bowel were significantly lower on the CTV‐M‐based plan than on the CTV‐D‐based plan (p = 0.001, 0.011, and 0.001, respectively). Conclusion CTV‐D provided more satisfactory NCC than CTV‐K and CTV‐S. CTV‐M provided the same satisfactory NCC as CTV‐D and reduced the dose to the critical structures.

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Multi-institutional Observational Study of Prophylactic Extended-Field Concurrent Chemoradiation Therapy Using Weekly Cisplatin for Patients With Pelvic Node-Positive Cervical Cancer in East and Southeast Asia

Cited by 11 publications

References 33 publications

The best postoperative adjuvant therapy for patients with early stage cervical adenosquamous carcinoma

The best postoperative adjuvant therapy for patients with early stage cervical adenosquamous carcinoma

Clinical Observation of Prophylactic Extended-Field Intensity-Modulated Radiation Therapy with Synchronous Chemotherapy in Locally Advanced Cervical Cancer

A modified delineation method of para‐aortic nodal clinical target volume in patients with locally advanced cervical cancer

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