Predictors of Radiation Field Failure After Definitive Chemoradiation in Patients With Locally Advanced Cervical Cancer

Bae, Hyo Sook; Kim, Yeon-Joo; Lim, Myong Cheol; Seo, Seung‐Woo; Park, Sang-Yoon; Kang, Sokbom; Kim, Sun Ho; Kim, Joo-Young

doi:10.1097/igc.0000000000000662

Cited by 13 publications

(7 citation statements)

References 29 publications

(16 reference statements)

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“…In 167 patients treated with radiation therapy, patients with tumors of ≥ 4 cm in diameter had a > 2-fold higher local recurrence rate than patients with tumors of < 4 cm (30% vs. 11%, respectively) at median follow-up of 87 months. Similar results have been shown in many previous retrospective studies, and tumor size is an important and useful predictive variable for local control [ 11 – 13 ]. However, few studies have investigated whether tumor size affects local control in radiation therapy for stage IVA uterine cervical cancer alone.…”

Section: Discussionsupporting

confidence: 89%

Radiation therapy for stage IVA uterine cervical cancer: treatment outcomes including prognostic factors and risk of vesicovaginal and rectovaginal fistulas

et al. 2017

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PurposeTo evaluate the safety and efficacy of radiation therapy for stage IVA uterine cervical cancer and to identify an optimal radiation regimen.ResultsSeventeen of the 28 patients developed recurrence after radiation therapy (local recurrence in 10 and distant metastasis in 12). The local control and distant metastasis-free rates at 3 years in all patients were 61% and 49%, respectively. Fourteen patients died after radiation therapy, and all but 2 died of tumor progression. The disease-free, cause-specific, and overall survival rates at 3 years in all patients were 32%, 49%, and 45%, respectively, and the estimated median survival time was 32 months. Tumor size (P = 0.007) and involvement in the lower third of vagina (P = 0.006) were significant prognostic factors for local control. Older age (P = 0.018) and performance status (P = 0.020) were significant prognostic factors for distant metastasis. The presence of hydronephrosis was the sole significant prognostic factor for survival (P = 0.026). Only 2 patients developed grade 3 late toxicities (vesicovaginal fistula and radiation proctitis, respectively).Materials and MethodsTwenty-eight patients with stage IVA uterine cervical cancer received radiation therapy. All patients initially received external pelvic irradiation at a median dose of 50.4 Gy in 28 fractions. Twenty patients also received high-dose-rate intracavitary brachytherapy at a median dose of 22 Gy in 4 fractions. These fraction sizes were lower than conventional sizes. The total median dose for all 28 patients was 68.7 Gy.ConclusionsRadiation therapy is safe and effective for treatment of stage IVA uterine cervical cancer. The reduced radiation dose per fraction may contribute to the prevention of vesicovaginal fistula formation.

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Section: Discussionsupporting

confidence: 89%

Radiation therapy for stage IVA uterine cervical cancer: treatment outcomes including prognostic factors and risk of vesicovaginal and rectovaginal fistulas

et al. 2017

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“…Recent study about radiation field failure after definitive CCRT in patients with locally advanced cervical cancer (stage IB-IVA) reported that the estimated 3-year rate of locoregional control was about 89% [7]. There are variables that affect in-field failure, such as tumor size (>5 cm), young age (<40 years), non-squamous histology and positive LN [7]. It is assumed that control of metastatic regional LNs will be of clinical significance in patients who do not have local failure.…”

Section: Introductionmentioning

confidence: 99%

Clinical significance of lymph node size in locally advanced cervical cancer treated with concurrent chemoradiotherapy

Seol

Choi

et al. 2019

Yeungnam Univ J Med

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BackgroundThis study aimed to assess the in-field lymph node (LN) failure rate according to LN size and to investigate effect of LN size on the survival outcome of patients with locally advanced cervical carcinoma treated with concurrent chemoradiotherapy (CCRT).MethodsA total of 310 patients with locally advanced cervical carcinoma treated with CCRT were enrolled in retrospective study. LN status was evaluated by magnetic resonance imaging. All patients received conventional external beam irradiation and high-dose rate brachytherapy, and concurrent cisplatin-based chemotherapy. In-field LN failure rate according to LN size was analyzed.ResultsThe median follow-up period was 83 months (range, 3-201 months). In-field LN failure rate in patients with pelvic LN size more than 10 mm was significantly higher than that in patients with pelvic LN size less than 10 mm (p<0.001). A similar finding was observed in the in-field para-aortic LN (PALN) failure rate (p=0.024). The pelvic and PALN size (≥10 mm) was a significant prognostic factor of overall-survival (OS) and disease-free survival rate in univariate and multivariate analyses. The OS rate was significantly different between groups according to LN size (<10 mm vs. ≥10 mm).ConclusionA LN of less than 10 mm in size in an imaging study is controlled by CCRT. On the other hand, in LN of more than 10 mm in size, the in-field LN failure rate increase and the prognosis deteriorate. Therefore, a more aggressive treatment strategy is needed.

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“…According to the previous studies, both staging and lymph involvement are factors affecting the prognosis of cervical cancer [24][25][26]. As we all know, the FIGO 2018 guidelines include lymph node metastasis in the staging.…”

Section: Discussionmentioning

confidence: 99%

“…This shows that icotinib combined with concurrent radiotherapy may have a greater survival benefit for patients with lymph node metastasis, although this needs to be confirmed by a further phase III clinical study. Hyo [28] retrospectively analyzed 392 patients, and found that the local recurrence rate of advanced cervical cancer (stage III-IV) was significantly higher than that of early cervical cancer (21.5% vs. 10.7%, p < 0.05). The current study found that the 5-year OS of stage III was 34.1%, significantly lower than that of stage II (75.5%), which is consistent with previous studies.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of icotinib combined with concurrent chemoradiotherapy in locally advanced cervical cancer

Liu¹,

Liu²,

Sun³

et al. 2021

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Concurrent chemoradiotherapy (CRT) based on cisplatin is recognized as the current standard treatment for locally advanced cervical cancer. The treatment of cervical cancer has reached a plateau in the last 20 years. Previous studies have proven that the epidermal growth factor receptor is correlated with chemo-and radioresistance and treatment failure. Hence, the purpose of this study was to investigate the efficacy and safety of icotinib combined with CRT in the treatment of locally advanced cervical cancer.Eligibility criteria included patients treated in the radiotherapy department of Taizhou Central Hospital of Zhejiang Province for stage IIB to IIIB cervical cancers who had not received anti-tumor treatment before and a performance status of 0 to 2. Patients were given icotinib 125 mg three times a day for 6 weeks, which was one week before the start of radiotherapy (500 centigrays in 28 fractions) and chemotherapy (40 mg/m 2 administered weekly for 3-5 cycles).There were 29 patients who completed the I + CRT treatment, and it was tolerated well. The median follow-up time was 50 months and 27 patients (93.10%) achieved complete responses. The 5-year cumulative overall survival rate and disease-free survival rate were 60.9% and 58.4%, respectively.The treatment with I + CRT is safe and effective for locally advanced cervical cancer. As far as we know, this is the first study to report the 5-year survival rate of locally advanced cervical cancer with targeted therapy combined with chemoradiotherapy.

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Predictors of Radiation Field Failure After Definitive Chemoradiation in Patients With Locally Advanced Cervical Cancer

Cited by 13 publications

References 29 publications

Radiation therapy for stage IVA uterine cervical cancer: treatment outcomes including prognostic factors and risk of vesicovaginal and rectovaginal fistulas

Radiation therapy for stage IVA uterine cervical cancer: treatment outcomes including prognostic factors and risk of vesicovaginal and rectovaginal fistulas

Clinical significance of lymph node size in locally advanced cervical cancer treated with concurrent chemoradiotherapy

Outcomes of icotinib combined with concurrent chemoradiotherapy in locally advanced cervical cancer

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