Validation and applicability of para-aortic lymph nodal contouring atlas in cervical cancer

Srinivasan, Shashank; Gurram, Lavanya; Johnny, Carlton; Chopra, Supriya; Dheera, A.; Baheti, Akshay D.; Popat, Palak; Sable, Nilesh; Rangarajan, Venkatesh; Mahantshetty, Umesh

doi:10.1016/j.radonc.2021.10.014

Cited by 3 publications

(3 citation statements)

References 17 publications

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Section: Resultsmentioning

confidence: 99%

“…Most commonly the lymph nodes were observed around the aorta (94%), while only approximately 6% of patients had the nodes around the inferior vena cava (IVC). Table 3 shows details of the anatomic distribution of lymph nodes in relation to major vessels as suggested by the study by Srinivasan et al 12 All the structures including PTV and OARs met the planning objectives except the bowel bag. Table 4 summarises the dosimetric comparison of PTV and OARs between the three plans.…”

Section: Resultsmentioning

confidence: 99%

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Dosimetric comparison of sequential intensity-modulated radiation therapy (IMRT) and simultaneous integrated boost IMRT for lymph node-positive cervical cancer

Mohanty,

Hajare,

Gurram

et al. 2023

J Radiother Pract

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Introduction: Nodal boost is being increasingly employed to escalate the dose to involved nodes in node-positive cervical cancer. The study aimed to compare the dosimetric differences between sequential boost intensity-modulated radiation therapy (SeB-IMRT) and simultaneous integrated boost IMRT (SIB-IMRT) in terms of target coverage and organs-at-risk (OARs) with special emphasis on the effect of nodal shrinkage and anatomical change of normal tissues during radiotherapy. Methods: Two computed tomography (CT) datasets (of phase I and phase II) of 40 patients of node-positive cervical cancer treated with SeB-IMRT [planning target volume (PTV) 45/25] followed by SeB to residual nodes (PTV 12·6/7) were utilised. SIB-IMRT1 plan consisted of PTV pelvis and para-aortic nodal region (PTV 45/25) and SIB to gross nodes (PTV 55/25). In order to account for the change in nodal and normal tissue topography during treatment, a third plan (SIB-IMRT2) was generated by utilising the SIB-IMRT1 plan for 44 Gy in 20 fractions and reproducing the plan on the second CT dataset for 11 Gy in 5 fractions. Dosimetric parameters of the three plans were compared using the Friedman test with Bonferroni correction. Results: We observed that the doses to OARs (bowel, rectum and bladder) were significantly higher in SeB-IMRT plan as compared to the SIB-IMRT plans. V40 Gy of bowel for SeB-IMRT, SIB-IMRT1 and SIB-IMRT2 plans were 354·8 cc, 271 cc and 321·8 cc, respectively (p = 0·001), whereas V30 Gy were 687·8 cc, 635·5 cc and 680 cc, respectively (p = 0·001). The target coverage was marginally better in SeB-IMRT plan as compared to SIB-IMRT1 and SIB-IMRT2 plans (V95% = 99·2 versus 97·7 versus 97·9, respectively, p = 0·000) Conclusion: SIB-IMRT led to better sparing of OARs, especially bowel. However, the magnitude of benefit decreases if the change in nodal and normal tissue topography during radiotherapy is not considered implying the need for frequent image guidance when SIB-IMRT is planned for node-positive cervical cancer.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Dosimetric comparison of sequential intensity-modulated radiation therapy (IMRT) and simultaneous integrated boost IMRT for lymph node-positive cervical cancer

Mohanty,

Hajare,

Gurram

et al. 2023

J Radiother Pract

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“…Delineation atlases for the para-aortic region based on anatomic principles or marginal expansion around the aorta and inferior vena cava have been previously proposed 11–16. However, the definition of the para-aortic region for the optimal therapeutic ratio of para-aortic radiotherapy remains unclear in locally advanced cervical cancer 15–17. Anatomy-based and margin-based para-aortic delineations have been reported to have different para-aortic nodal coverages that may affect failure patterns.…”

Section: Introductionmentioning

confidence: 99%

Optimal prophylactic para-aortic radiotherapy in locally advanced cervical cancer: anatomy-based versus margin-based delineation

Lee

Lin

Chang

et al. 2022

Int J Gynecol Cancer

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ObjectivePrecise delineation of the para-aortic nodal region is critical for the optimal therapeutic ratio of prophylactic para-aortic radiotherapy. We aimed to evaluate the para-aortic control and patient-reported gastrointestinal toxicity in patients with locally advanced cervical cancer who received anatomy-based or margin-based prophylactic para-aortic radiotherapy.MethodsWe analyzed 160 patients with locally advanced cervical cancer who received prophylactic extended-field radiotherapy between January 2014 and November 2019 at two tertiary centers. Para-aortic nodal regions were delineated based on the anatomic principle-based atlas or marginal expansion from the aorta and inferior vena cava. The Patient-Reported Outcome version of the Common Terminology Criteria for Adverse Events was used to assess acute gastrointestinal toxicity, and a score of ≥3 was defined as severe gastrointestinal toxicity.ResultsSeventy-six (47.5%) and 84 (52.5%) patients received anatomy-based and margin-based prophylactic para-aortic radiotherapy, respectively. The median follow-up was 40.1 months (IQR 25.5–58.9). Para-aortic nodal failures occurred in one (1.3%) patient in the anatomy-based para-aortic radiotherapy group and in one (1.2%) patient in the margin-based para-aortic radiotherapy group (p=1.00). There was no in-field or marginal para-aortic nodal failure. The 3-year para-aortic recurrence-free survival for anatomy-based and margin-based para-aortic radiotherapy was 98.6% and 98.8%, respectively (p=0.94). Patients who received anatomy-based para-aortic radiotherapy reported less severe acute gastrointestinal toxicity than those who received margin-based para-aortic radiotherapy (13.2% vs 29.8%, p=0.01). A comparison of gastrointestinal toxicities showed that patients who received anatomy-based para-aortic radiotherapy reported significantly less severe gastrointestinal toxicity than those who received margin-based para-aortic radiotherapy in terms of frequency of diarrhea (7.9% vs 20.2%, p=0.03), severity of abdominal pain (3.9% vs 14.3%, p=0.03), and interference of abdominal pain (2.6% vs 11.9%, p=0.03).ConclusionAnatomy-based prophylactic para-aortic radiotherapy achieved excellent para-aortic control and a lower incidence of severe patient-reported gastrointestinal toxicity. These findings suggest that anatomy-based delineation optimizes clinical outcomes of prophylactic para-aortic radiotherapy in locally advanced cervical cancer.

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Clinical Outcomes and Prognostic Factors in Stage III C Cervical Cancer Patients Treated with Radical Radiotherapy or Radiochemotherapy

Zhang,

Yu,

Xiu

et al. 2024

Technol Cancer Res Treat

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Objective: Since the update of the 2018 International Federation of Gynecology and Obstetrics (FIGO) staging criteria, there have been few reports on the prognosis of stage III C cervical cancer. Moreover, some studies have drawn controversial conclusions, necessitating further verification. This study aims to evaluate the clinical outcomes and determine the prognostic factors for stage III C cervical cancer patients treated with radical radiotherapy or radiochemotherapy. Methods: The data of 117 stage III C cervical cancer patients (98 III C1 and 19 III C2) who underwent radical radiotherapy or radiochemotherapy were retrospectively analyzed. We evaluated 3-year overall survival (OS) and disease-free survival (DFS) using the Kaplan–Meier method. Prognostic factors were analyzed using the Log-rank test and Cox proportional hazard regression model. The risk of para-aortic lymph node metastasis (LNM) in all patients was assessed through Chi-squared test and logistic regression analysis. Results: For stage III C1 and III C2 patients, the 3-year OS rates were 77.6% and 63.2% ( P = .042), and the 3-year DFS rates were 70.4% and 47.4% ( P = .003), respectively. The pretreatment location of pelvic LNM, histological type, and FIGO stage was associated with OS ( P = .033, .003, .042, respectively); the number of pelvic LNM and FIGO stage were associated with DFS ( P = .015, .003, respectively). The histological type was an independent prognostic indicator for OS, and the numbers of pelvic LNM and FIGO stage were independent prognostic indicators for DFS. Furthermore, a pelvic LNM largest short-axis diameter ≥ 1.5 cm and the presence of common iliac LNM were identified as high-risk factors influencing para-aortic LNM in stage III C patients ( P = .046, .006, respectively). Conclusions: The results of this study validated the 2018 FIGO staging criteria for stage III C cervical cancer patients undergoing concurrent chemoradiotherapy. These findings may enhance our understanding of the updated staging criteria and contribute to better management of patients in stage III C.

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Validation and applicability of para-aortic lymph nodal contouring atlas in cervical cancer

Cited by 3 publications

References 17 publications

Dosimetric comparison of sequential intensity-modulated radiation therapy (IMRT) and simultaneous integrated boost IMRT for lymph node-positive cervical cancer

Dosimetric comparison of sequential intensity-modulated radiation therapy (IMRT) and simultaneous integrated boost IMRT for lymph node-positive cervical cancer

Optimal prophylactic para-aortic radiotherapy in locally advanced cervical cancer: anatomy-based versus margin-based delineation

Clinical Outcomes and Prognostic Factors in Stage III C Cervical Cancer Patients Treated with Radical Radiotherapy or Radiochemotherapy

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