Impact of nodal boost irradiation and MR-based brachytherapy on oncologic outcomes in node-positive cervical cancer
| Autor: | Sowmya Narayanan, Geeta S. Narayanan, Vaishnavi Perumal Reddy, Ramya Venugopal, Richa Tiwari, Bhaskar Vishwanathan |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
medicine.medical_specialty medicine.medical_treatment Brachytherapy Locally advanced Uterine Cervical Neoplasms medicine Humans In patient Prospective Studies Treatment Failure Cervical cancer Pelvic control business.industry Standard treatment Obstetrics and Gynecology Middle Aged medicine.disease Magnetic Resonance Imaging Oncology Lymphatic Metastasis Boost irradiation Female Lymph Nodes Radiotherapy Intensity-Modulated Radiology business NODAL Radiotherapy Image-Guided |
| Zdroj: | Gynecologic Oncology. 163:110-116 |
| ISSN: | 0090-8258 |
| DOI: | 10.1016/j.ygyno.2021.07.023 |
| Popis: | This study aimed to prospectively evaluate the impact of dose-escalated irradiation of nodal metastases on clinical outcomes compared to no boost in patients with node-positive, bulky, locally advanced cervical cancer (LACC) undergoing standard chemoradiation and MRI-based brachytherapy.This comparative study included 161 patients with node-positive LACC treated with definitive chemoradiation and MRI-based brachytherapy. The prospective Boost arm accrued 71 patients to receive nodal boost either sequentially or simultaneously to an equivalent dose of 60 Gy. The control arm comprised 90 patients treated before this protocol period with no additional nodal boost.Baseline patient and tumor characteristics were similar in both groups. All patients had at least one tumor dimension5 cm at presentation, and 31% had para-aortic node involvement. With a median follow-up of 36 months (IQR:19-50.5), the overall 3-year Local control rate was 88.8%. The 3-year Regional control (93% vs. 80%, p = 0.035) was statistically better in the Boost arm. No nodal failure was observed in nodes3 cc and2 cm, even in the No-boost arm. There was no significant difference in Disease-free survival (67.6% vs. 58.9%,p = 0.454) and Overall Survival (78.9% vs. 74.4%,p = 0.87) between the two arms. Incidence of acute or late toxicities did not differ significantly with nodal boost or the boost delivery technique.The addition of external radiation nodal boost to standard treatment of high-volume cervical cancer has improved pelvic control with an acceptable rate of toxicities. However, high systemic failures continue to pose a challenge in improving survival outcomes. |
| Databáze: | OpenAIRE |
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