Cancer Management and Research (Sep 2014)

Is extended-field concurrent chemoradiation an option for radiologic negative paraaortic lymph node, locally advanced cervical cancer?

  • Asiri MA,
  • Tunio MA,
  • Mohamed R,
  • Bayoumi Y,
  • Alhadab A,
  • Saleh RM,
  • AlArifi MS,
  • Alobaid A

Journal volume & issue
Vol. 2014, no. default
pp. 339 – 348

Abstract

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Mushabbab Al Asiri,1 Mutahir A Tunio,1 Reham Mohamed,2 Yasser Bayoumi,2 Abdulrehman Alhadab,1 Rasha M Saleh,3 Muhannad Saud AlArifi,1 Abdelaziz Alobaid4 1Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia; 2Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt; 3Medical Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia; 4Women's Specialized Hospital, King Fahad Medical City, Riyadh, Saudi ArabiaBackground: The aim was to evaluate whether extended-field concurrent chemoradiation (EF-CCRT) leads to results better than those obtained by standard whole-pelvis concurrent chemoradiation (WP-CCRT) in locally advanced cervical cancer with radiologic negative paraaortic lymph nodes (PALNs).Patients and methods: A total of 102 patients with histopathologically proven squamous cell carcinoma, adenocarcinoma, or adenosquamous cell carcinoma, and radiologic negative PALN locally advanced cervical cancer, stage IIB-IVA, were accrued between July 2007 and April 2008 and were randomly assigned to WP-CCRT (50 patients) or EF-CCRT (52 patients), followed by high-dose rate brachytherapy. Data regarding the safety profile, response rates, and occurrence of local, PALN, or distant failure were recorded.Results: During a median follow-up time of 60 months (18–66), 74/102 patients completed the treatment protocol and were analyzed. Overall PALN, distant-metastasis control, disease-free survival, and overall survival rates were 97.1%, 86.9%, 80.3%, and 72.4% in EF-CCRT respectively in comparison with WP-CCRT (82.1%,74.7%, 69.1%, and 60.4%), with P-values of 0.02, 0.03, 0.03 and 0.04 respectively. No difference in acute toxicity profile was seen between the groups, and late toxicities were mild and minimal.Conclusion: Prophylactic EF-CCRT can be a reasonable option in patients with locally advanced cervical cancer with radiologic positive pelvic lymph nodes and radiologic negative PALN.Keywords: prophylactic extended field radiation therapy, concurrent chemotherapy