Does External Beam Radiation Boost to Pelvic Lymph Nodes Reduce Recurrence Rate in Patients with Locally Advanced Cervical Cancer?


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Caryn Wujanto1,Liang Shen2,David SP Tan1,Yiat Horng Leong3,Johann Tang3,Vicky Koh1
1National University Hospital, Singapore,2National University Singapore,3National University Hospital, SIngapore

Abstract

Background

Current recommendation for locally advanced cervical cancer includes pelvic external beam radiation therapy (EBRT) with concurrent chemotherapy followed by brachytherapy. Involvement of pelvic lymph nodes is an important prognostic factor and recurrence commonly occurs following definitive treatment. To date there is no standard recommendation for EBRT boost to pelvic lymph nodes, hence our study aims to assess if this would benefit survival, recurrence rate and toxicity. 

Method

A retrospective review of patients with FIGO stage IA to IVA treated with EBRT for cervical cancer between 2008 to 2015 was performed. Diagnosis was confirmed on histology and lymph node involvement was assessed based on CT, MRI or PET scan. Radiologically suspicious lymph nodes or those > 10 mm in diameter or SUVmax > 2.5 were interpreted as involved. The dose of EBRT ranged from 45 to 50.4 Gy in 1.8 Gy daily fractions over 25 to 28 fractions. In patients receiving additional boost, the total dose ranged from 55.4 Gy to 70.2 Gy given over 30 to 33 fractions. All patients subsequently underwent high dose rate intra-cavitary brachytherapy. Surveillance for recurrences consisted of regular clinical & radiological assessment and biopsy in suspicious cases.

Results

Of 139 patients, 67 patients had involved lymph nodes at diagnosis and included for further analysis. Squamous cell carcinoma was the most common histology in 79% patients. Concurrent chemotherapy was given in 89.6% of patients. The median EBRT dose given was 55.8 Gy (range 43.2 Gy to 70.2 Gy). EBRT boost to the pelvic lymph nodes was given in 53.6% patients. There was no significant difference in the 3-year overall survival, recurrence rate and toxicities with EBRT boost to pelvic lymph nodes.

Conclusion

This study showed that EBRT boost to pelvic lymph nodes does not significantly improve survival and recurrence rates in locally advanced cervical cancer with involved lymph nodes.