Extended-Field Intensity-Modulated Radiotherapy and Concurrent Cisplatin-Based Chemotherapy for Postoperative Cervical Cancer With Common Iliac or Para-Aortic Lymph Node Metastases: A Retrospective Review in a Single Institution

2012 ◽  
Vol 22 (7) ◽  
pp. 1220-1225 ◽  
Author(s):  
Guangyu Zhang ◽  
Chunli Fu ◽  
Youzhong Zhang ◽  
Jianbo Wang ◽  
Naian Qiao ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Field Intensity ◽  
Intensity Modulated Radiotherapy ◽  
Endocrine Function ◽  
Ovarian Transposition ◽  
Intensity Modulated ◽  
Extended Field ◽  
Grade 3

ObjectiveRetrospectively, to assess the toxicity of delivering postoperative extended-field intensity-modulated radiotherapy (EF-IMRT) and concurrent cisplatin chemotherapy for patients with cervical cancer with a pathologically confirmed positive common iliac node and/or a para-aortic node.MethodsEach patient received postoperative EF-IMRT and concurrent cisplatin chemotherapy. The clinical target volume included regional lymph node regions (obturator; common, internal, and external iliac nodal regions; presacral region; and para-aortic regions) and the upper 2.0 cm of the vagina and paravaginal soft tissue lateral to the vagina. The acute and late toxicity were scored using the Common Terminology Criteria for Adverse Events (CTCAE) and the Radiation Therapy Oncology Group late radiation morbidity scoring criteria, respectively.ResultsFifty-eight patients were treated with postoperative EF-IMRT and concurrent cisplatin chemotherapy. The median follow-up was 34 months. Eighteen patients (31%) had recurrence. The region of recurrence was in-field in 2 patients (3.4%) and out-field in 16 patients (27.6%). Acute grade 3 or higher gastrointestinal, genitourinary, and hematologic toxicity occurred in 2, 1, and 11patients, respectively. Three patients (5.1%) had late grade 3 toxicities. Thirteen patients experienced ovarian transposition; of these, 10 patients (77%) maintained ovarian function. Forty-one patients (71%) were alive at the last follow-up.ConclusionsConcurrent cisplatin chemotherapy with postoperative EF-IMRT was safe and well tolerated. The acute and late toxicities are acceptable. The locoregional control rates are hopeful, although distant metastases continue to be the primary mode of failure. Postoperative EF-IMRT provides an opportunity to preserve endocrine function for patients with ovarian transposition.

scholarly journals Adjuvant pelvic intensity-modulated radiotherapy and concurrent docetaxel and cisplatin chemotherapy for postoperative cervical cancer with adverse risk factors: a retrospective report on toxicity and outcome in a single institution

2020 ◽  
Author(s):  
Guangyu Zhang ◽  
Fangfang He ◽  
Youzhong Zhang ◽  
Haijian Wu ◽  
Qingwei Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cervical Cancer ◽  
Intensity Modulated Radiotherapy ◽  
Endocrine Function ◽  
Hematologic Toxicity ◽  
Ovarian Transposition ◽  
Intensity Modulated ◽  
Grade 3 ◽  
Docetaxel Chemotherapy

Abstract Background: To retrospectively assess the toxicity of delivering postoperative intensity-modulated radiotherapy (IMRT) and concurrent cisplatin and docetaxel chemotherapy to patients with cervical cancer and adverse risk factors.Methods: Every patient received postoperative IMRT and concurrent cisplatin and docetaxel chemotherapy. The clinical target volume (CTV) included the regional lymph node regions (obturator, common, internal, and external iliacs and presacral and para-aortic regions); the upper 2.0 cm of the vagina; and paravaginal soft tissue lateral to the vagina. Acute and late toxicities were scored using the Common Terminology Criteria for Adverse Events (CTCAE) and the Radiation Therapy Oncology Group (RTOG) late radiation morbidity scoring criteria, respectively.Results: Seventy-six patients were treated with postoperative IMRT and concurrent cisplatin and docetaxel chemotherapy. The median follow-up was 32 months. Eight patients (10.5%) had recurrence—loco-regional recurrence in four patients (5.3%) and distant metastasis in four (5.2%). Acute grade ≥3 gastrointestinal and hematologic toxicity occurred in one and five patients, respectively. One patient (1.3%) suffered from late grade 3 toxicities. Seventeen patients experienced ovarian transposition, 14 (82%) of whom maintained ovarian function. Seventy-four patients (97.4%) were alive at the last follow-up.Conclusions: Concurrent cisplatin and docetaxel chemotherapy with postoperative IMRT was safe and well tolerated, with acceptable acute and late toxicities. Moreover, the distant metastases control rates were encouraging, although loco-regional failure continued to be the primary mode of failure. Postoperative IMRT provides an opportunity to preserve endocrine function for patients with ovarian transposition.

Low-Dose, Prophylactic, Extended-Field, Intensity-Modulated Radiotherapy Plus Concurrent Weekly Cisplatin for Patients With Stage IB2-IIIB Cervical Cancer, Positive Pelvic Lymph Nodes, and Negative Para-aortic Lymph Nodes

2014 ◽  
Vol 24 (5) ◽  
pp. 901-907 ◽  
Author(s):  
Ji-An Liang ◽  
Shang-Wen Chen ◽  
Yao-Ching Hung ◽  
Lian-Shung Yeh ◽  
Wei-Chun Chang ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Nodes ◽  
Field Intensity ◽  
Low Dose ◽  
Intensity Modulated Radiotherapy ◽  
Free Survival ◽  
Intensity Modulated ◽  
Extended Field ◽  
Grade 3 ◽  
Weekly Cisplatin

ObjectiveThe objective of this study was to assess prospectively the clinical outcomes of low-dose prophylactic extended-field, intensity-modulated radiotherapy (IMRT) plus concurrent weekly cisplatin for patients with stage IB2-IIIB cervical cancer, positive pelvic lymph nodes (PLNs), and negative para-aortic lymph nodes (PALNs).MethodsThirty-two patients with stage IB2-IIIB cervical cancer with positive PLN and negative PALN were included prospectively. All lymph nodes were assessed with positron emission tomography. The PALN field, including lymphatics from the superior border of L1 to the L4-L5 interphase, was irradiated concurrently with pelvic IMRT with a prescribed dose of 40 Gy in 25 fractions. Chemotherapy consisted of cisplatin delivered weekly at a dose of 40 mg/m2. Using historical controls treated with pelvic radiotherapy, the survival curves were compared to assess the difference between the 2 treatment periods.ResultsThirty-one patients completed the allocated extended-field IMRT, and all finished the planned pelvic IMRT and brachytherapy. Acute ≥ grade 3 gastrointestinal, genitourinary, and hematologic toxicities were seen in 2, 1, and 18 patients, respectively. During a median follow-up of 33 months, 5 patients developed out-field distant recurrences. One patient had a late grade 3 gastrointestinal complication, and 1 patient had genitourinary toxicity. The 3-year actuarial overall survival, disease-free survival, and distant metastasis–free survival for the study cohort and historic controls were 87% versus 62% (P = 0.02), 82% versus 54% (P = 0.02), and 79% versus 57% (P = 0.01), respectively.ConclusionsExtended-field IMRT of 40 Gy to the PALN plus concurrent cisplatin can effectively eradicate subclinical disease at the PALN and improve the outcome for patients with PLN-positive stage IB2-IIIB cervical cancer.

scholarly journals Long-Term Toxicity and Efficacy of Intensity-Modulated Radiation Therapy in Cervical Cancers: Experience of a Cancer Hospital in Pakistan

2020 ◽  
pp. 1639-1646
Author(s):  
Muhammad Atif Mansha ◽  
Tabinda Sadaf ◽  
Asmara Waheed ◽  
Amna Munawar ◽  
Asma Rashid ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
Lymph Node ◽  
Tumor Size ◽  
Intensity Modulated Radiation Therapy ◽  
Disease Free Survival ◽  
Intensity Modulated ◽  
Significant Difference ◽  
Grade 3

PURPOSE To report the chronic toxicity and disease outcomes attributable to intensity-modulated radiation therapy (IMRT) in patients with cervical cancer. METHODS AND MATERIALS Between January 2014 and December 2018, a retrospective review of medical records of patients with cervical cancer who received radiation therapy with IMRT was performed. Disease and treatment-related details were documented. Follow-up notes were reviewed, and severity of late toxicities was recorded. Overall survival (OS) and disease-free survival (DFS) at 3 years were estimated. RESULTS A total of 222 patients’ records were reviewed. Mean age was 50.7 years. Median follow-up duration was 33 months (range, 2-70 months). The most common toxicity was vaginal stricture (grade 2, n = 59, 26.6%; grade 3, n = 4, 1.80%), followed by proctitis (grade 2, n = 24; 10.8%; grade 3, n = 7; 3.20%). Seven patients (grade 2, n = 5, 2.3%; grade 3, n = 2; 0.90%) developed cystitis, and only 5 (grade 2; 2.3%) were found to have colitis. None of the patients had grade 4 or grade 5 toxicities. There was a significant difference in late complications in patients with nodal disease or those who underwent prior surgery ( P < .05). Three-year OS and DFS rates were 79.7% and 81.9%, respectively. Patients with tumor size > 5 cm and those with pelvic lymph node metastasis had poor survival rates ( P < .05). CONCLUSION IMRT is an effective and well-tolerated technique that should be considered in patients with lymph node disease and in postoperative patients. There is an inverse relationship between tumor size and nodal involvement with respect to OS and DFS.

scholarly journals Extended field intensity-modulated radiotherapy plus concurrent nedaplatin treatment in cervical cancer

2016 ◽  
Vol 11 (5) ◽  
pp. 3421-3427 ◽  
Author(s):  
YUNQIN LIU ◽  
JINMING YU ◽  
LITING QIAN ◽  
HONGYAN ZHANG ◽  
JUN MA
Keyword(s):  
Cervical Cancer ◽  
Field Intensity ◽  
Intensity Modulated Radiotherapy ◽  
Intensity Modulated ◽  
Extended Field

Extended-field intensity-modulated radiation therapy combined with concurrent chemotherapy for cervical cancer with para-aortic lymph nodes metastasis

2018 ◽  
Vol 49 (3) ◽  
pp. 263-269 ◽  
Author(s):  
Xiaoliang Liu ◽  
Weiping Wang ◽  
Qingyu Meng ◽  
Fuquang Zhang ◽  
Ke Hu
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
Lymph Nodes ◽  
Field Intensity ◽  
Intensity Modulated Radiation Therapy ◽  
Concurrent Chemotherapy ◽  
Intensity Modulated ◽  
Genitourinary Toxicity ◽  
Extended Field ◽  
Grade 3

Abstract Objective This study was conducted to evaluate the efficacy and toxicity of extended-field intensity-modulated radiation therapy combined with concurrent chemotherapy in patients with cervical cancer with positive para-aortic lymph nodes (PALN). Methods From September 2007 to December 2014, a total of 59 patients who had cervical cancer with para-aortic lymph node metastasis were treated with concurrent chemoradiotherapy at our institution. A dose of 45–50.4 Gy in 25–28 fractions with extended-field intensity-modulated radiation therapy was prescribed to planning target volume, and a dose of 30–36 Gy in 5–6 fractions was prescribed to Point A with high-dose-rate brachytherapy. A concurrent first-line cisplatin-based chemotherapy regimen was used. Results The median duration of follow-up was 32.1 months (range, 3.2–103.7 months). The 2- and 3-year overall survival, disease-free survival and local control rates were 69.0 and 52.8%, 45.0 and 41.3% and 83.4 and 81.0%, respectively. Distant metastasis was the major pattern of treatment failure, which occurred in 26 patients (44.1%). The incidence of Grade 3 or greater acute hematologic, gastrointestinal and genitourinary toxicity was 50.9, 1.7 and 3.4%, respectively. Only one patient had both Grade 3 late gastrointestinal and genitourinary toxicity. Conclusions The study found that extended-field intensity-modulated radiation therapy combined with concurrent chemotherapy was safe and effective in patients who had cervical cancer with positive PALN.

scholarly journals Extended-field intensity-modulated radiotherapy and dosage boost for lymph node metastasis are beneficial for the prognosis of FIGO IIICr and IVA cervical cancer patients with positive regional lymph nodes

2020 ◽  
Author(s):  
Yuhua Zhao ◽  
Gong Li ◽  
Lei Gao
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Intensity Modulated Radiotherapy ◽  
Figo Stage ◽  
Concurrent Chemotherapy ◽  
Regional Lymph Nodes ◽  
Free Survival ◽  
Node Metastasis ◽  
Extended Field

Abstract Background: This study aimed to evaluate the therapeutic efficacy of extended-field intensity-modulated radiotherapy (EF-IMRT) and dosage boost for positive lymph nodes, prognostic factors, treatment failure, and toxicity for Federation of Gynecology and Obstetrics (FIGO) stage IIICr and IVA cervical cancer patients with positive regional lymph nodes.Methods: We retrospectively evaluated 34 patients with stage IIICr and IVA who had received treatment in our institute between 2013 and 2016. Patients with stage IVA cervical cancer who had been enrolled in the analysis all had positive regional lymph nodes (pelvic or/and para-aortic). All 34 patients were treated with EF-IMRT and simultaneously integrated boost-IMRT (SIB-IMRT) for lymph node metastasis with concurrent chemotherapy and brachytherapy. Positive regional lymph nodes (short-axis diameter ≥5 mm in computed tomography [CT] or magnetic resonance imaging [MRI]) remaining after SIB-IMRT were then treated with sequential boost-IMRT (SeB-IMRT). The prognostic factors for overall survival (OS); disease-free survival (DFS); local control rate (LCR); regional control rate (RCR); distant metastasis-free survival (DMFS), including age, FIGO stage, pretreatment hemoglobin (HB) level, tumor size, para-aortic lymph node (PALN) metastasis, point A equivalent dose in 2-Gy fractions (EQD2 dose), concurrent chemotherapy, and adjuvant chemotherapy cycles, were analyzed.Results: Complete response (CR) was achieved in 31 (91.2%) patients with acceptable adverse effects. Notably, the three-year OS, DFS, LCR, RCR, DMFS for these patients were 73.5%, 70.6%, 88.1%, 87.9%, and 81.6%, respectively. In particular, the three-year OS, DFS, LCR, RCR, and DMFS of patients with positive PALNs was 41.7%, 33.3%, 65.6%, 72.2%, and 60.2%, respectively. The corresponding values in patients without positive PALNs were 90.9%, 90.9%, 100%, 95.5%, and 90.9%, respectively.Conclusions: Our study suggested that the EF-IMRT and nodal dosage boost decreased regional node failure and that patients with stage IIIC1r and IVA cervical cancer without PALN metastasis who received EF-IMRT and SIB-IMRT with or without SeB-IMRT had a significant survival advantage in terms of the DFS and OS.

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