TY - JOUR
T1 - Patterns of Recurrence in Node-Positive Cervical Cancer Patients Treated With Contemporary Chemoradiation and Dose Escalation
T2 - A Multi-Institutional Study
AU - Sethi, Rajni
AU - Mayadev, Jyoti S
AU - Sethi, Suresh
AU - Rash, Dominique
AU - Chen, Lee may
AU - Brooks, Rebecca
AU - Ueda, Stefanie
AU - Hsu, I. Chow
PY - 2019/3
Y1 - 2019/3
N2 - Purpose: We assessed the effect of elective extended field radiation (EFRT) and nodal dose escalation on locoregional control and survival in patients with node-positive cervical cancer treated with definitive chemoradiation at 2 academic institutions. Methods and Materials: Patients with cervical cancer with pelvic and/or paraortic lymph node (PALN) metastases treated with definitive chemoradiation between 2004 and 2011 were retrospectively reviewed. Patterns of failure were recorded. The impact of tumor and treatment on survival or recurrence were evaluated. Results: A total of 78 patients were included. Median follow-up in surviving patients was 34 months. The 3-year overall survival (OS) and disease-free survival (DFS) were 65% and 50%, respectively (all patients), 68% and 52% (pelvic lymph nodes), and 59% and 48% (PALN). OS or DFS in pelvic-only versus PALN-positive patients was not significantly different (log-rank P =.24). Recurrences were distant (n = 22), PALN (n = 6), central pelvis (n = 5), pelvic lymph node (n = 3), and suspended ovary (n = 1). Higher nodal prescribed dose (range, 45-60 Gy) and elective EFRT did not affect DFS or OS (Cox proportional hazards P >.05). There was a trend toward decreased regional recurrence with higher nodal dose (hazard ratio, 0.85 per Gy increase; Cox proportional hazards P =.08). Elective EFRT did not affect PALN failure rate, OS, or DFS (Cox proportional hazards P >.05). Conclusions: Survival of patients with PALN involvement was similar to those with pelvic-only nodes. Higher nodal dose may improve regional control but did not affect survival. Elective extended-field radiation did not affect outcomes in this cohort. Most failures were distant, emphasizing the potential role of systemic therapy to improve outcomes.
AB - Purpose: We assessed the effect of elective extended field radiation (EFRT) and nodal dose escalation on locoregional control and survival in patients with node-positive cervical cancer treated with definitive chemoradiation at 2 academic institutions. Methods and Materials: Patients with cervical cancer with pelvic and/or paraortic lymph node (PALN) metastases treated with definitive chemoradiation between 2004 and 2011 were retrospectively reviewed. Patterns of failure were recorded. The impact of tumor and treatment on survival or recurrence were evaluated. Results: A total of 78 patients were included. Median follow-up in surviving patients was 34 months. The 3-year overall survival (OS) and disease-free survival (DFS) were 65% and 50%, respectively (all patients), 68% and 52% (pelvic lymph nodes), and 59% and 48% (PALN). OS or DFS in pelvic-only versus PALN-positive patients was not significantly different (log-rank P =.24). Recurrences were distant (n = 22), PALN (n = 6), central pelvis (n = 5), pelvic lymph node (n = 3), and suspended ovary (n = 1). Higher nodal prescribed dose (range, 45-60 Gy) and elective EFRT did not affect DFS or OS (Cox proportional hazards P >.05). There was a trend toward decreased regional recurrence with higher nodal dose (hazard ratio, 0.85 per Gy increase; Cox proportional hazards P =.08). Elective EFRT did not affect PALN failure rate, OS, or DFS (Cox proportional hazards P >.05). Conclusions: Survival of patients with PALN involvement was similar to those with pelvic-only nodes. Higher nodal dose may improve regional control but did not affect survival. Elective extended-field radiation did not affect outcomes in this cohort. Most failures were distant, emphasizing the potential role of systemic therapy to improve outcomes.
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U2 - 10.1016/j.prro.2018.08.012
DO - 10.1016/j.prro.2018.08.012
M3 - Article
C2 - 30342181
AN - SCOPUS:85057832236
VL - 9
SP - e180-e186
JO - Practical Radiation Oncology
JF - Practical Radiation Oncology
SN - 1879-8500
IS - 2
ER -