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International Journal of Clinical Oncology

Erschienen in:

01.04.2014 | Original Article

Feasibility of extended-field irradiation and intracavitary brachytherapy combined with weekly cisplatin chemosensitization for IB2–IIIB cervical cancer with positive paraaortic or high common iliac lymph nodes: a retrospective review

verfasst von: Shiho Kuji, Yasuyuki Hirashima, Satomi Komeda, Aki Tanaka, Masakazu Abe, Nobutaka Takahashi, Munetaka Takekuma, Hirofumi Asakura, Hideyuki Harada, Tetsuo Nishimura

Erschienen in: International Journal of Clinical Oncology | Ausgabe 2/2014

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Abstract

Background

The aim of this retrospective study was to investigate the feasibility of primary treatment with extended-field irradiation and weekly cisplatin (extended-field concurrent chemoradiotherapy, EFCCRT) as initial therapy in patients with International Federation of Gynecology and Obstetrics IB1 to IIIB cervical cancer with paraaortic or high common iliac lymph node metastases.

Methods

Participants comprised patients with confirmed cervical cancer, showing paraaortic or high common iliac lymph node metastases on diagnostic imaging, treated with EFCCRT. Total external radiation doses were 50.4 Gy to the whole pelvis and 45.0 Gy to the lumbar paraaortic region. High-dose-rate intracavitary brachytherapy was performed to deliver a total dose of 18–24 Gy in 6-Gy fractions prescribed at point A. Weekly cisplatin (30–40 mg/m²) was given concurrently with radiotherapy.

Results

Twenty-four patients were treated. Median follow-up interval was 34 months. The dose of cisplatin was 30 mg/m² in 2 cases, 35 mg/m² in 8 cases, and 40 mg/m² in 14 cases. Twenty-two cases (92 %) received more than 160 mg/m² cisplatin. Ten cases (42 %) experienced acute grade 3/4 hematological toxicity, and 9 cases (38 %) experienced acute grade 3 nonhematological toxicity. No case presented late grade 3/4 toxicity. Three-year progression-free and overall survival rates were 54 % and 72 %, respectively. Eleven cases recurred during follow-up. Sites of recurrence were within the irradiation field in 4 cases, outside the field in 6 cases, and in both fields in 1 case.

Conclusion

EFCCRT and high-dose-rate intracavitary brachytherapy for patients with paraaortic or high common iliac lymph node metastases from cervical cancer is feasible.

Berman ML, Keys H, Creasman W et al (1984) Survival and patterns of recurrence in cervical cancer metastatic to periaortic lymph nodes (a Gynecologic Oncology Group study). Gynecol Oncol 19:8–16PubMedCrossRef

Sakuragi N, Satoh C, Takeda N et al (1999) Incidence and distribution pattern of pelvic and paraaortic lymph node metastasis in patients with stage IB, IIA, and IIB cervical carcinoma treated with radical hysterectomy. Cancer (Phila) 85:1547–1554CrossRef

Morice P, Castaigne D, Pautier P et al (1999) Interest of pelvic and paraaortic lymphadenectomy in patients with stage IB and II cervical carcinoma. Gynecol Oncol 73:106–110PubMedCrossRef

Varia MA, Bundy BN, Deppe G et al (1998) Cervical carcinoma metastatic to para-aortic nodes: extended field radiation therapy with concomitant 5-fluorouracil and cisplatin chemotherapy: a Gynecologic Oncology Group study. Int J Radiat Oncol Biol Phys 42:1015–1023PubMedCrossRef

Grigsby PW, Heydon K, Mutch DG et al (2001) Long-term follow-up of RTOG 92-10: cervical cancer with positive para-aortic lymph nodes. Int J Radiat Oncol Biol Phys 51:982–987PubMedCrossRef

Grigsby PW, Lu JD, Mutch DG et al (1998) Twice-daily fractionation of external irradiation with brachytherapy and chemotherapy in carcinoma of the cervix with positive para-aortic lymph nodes: phase II study of the Radiation Therapy Oncology Group 92-10. Int J Radiat Oncol Biol Phys 41:817–822PubMedCrossRef

Rose PG, Bundy BN, Watkins EB et al (1999) Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med 340:1144–1153PubMedCrossRef

Whitney CW, Sause W, Bundy BN et al (1999) Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage IIB–IVA carcinoma of the cervix with negative para-aortic lymph nodes: a Gynecologic Oncology Group and Southwest Oncology Group study. J Clin Oncol 17:1339–1348PubMed

Keys HM, Bundy BN, Stehman FB et al (1999) Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med 340:1154–1161PubMedCrossRef

10.

Pearcey R, Brundage M, Drouin P et al (2002) Phase III trial comparing radical radiotherapy with and without cisplatin chemotherapy in patients with advanced squamous cell cancer of the cervix. J Clin Oncol 20:966–972PubMedCrossRef

11.

Podczaski E, Stryker JA, Kaminski P et al (1990) Extended-field radiation therapy for carcinoma of the cervix. Cancer (Phila) 66:251–258CrossRef

12.

Kim YS, Kim JH, Ahn SD et al (2009) High-dose extended-field irradiation and high-dose-rate brachytherapy with concurrent chemotherapy for cervical cancer with positive para-aortic lymph nodes. Int J Radiat Oncol Biol Phys 74:1522–1528PubMedCrossRef

13.

Walker JL, Morrison A, DiSilvestro P et al (2009) A phase I/II study of extended field radiation therapy with concomitant paclitaxel and cisplatin chemotherapy in patients with cervical carcinoma metastatic to the para-aortic lymph nodes: a Gynecologic Oncology Group study. Gynecol Oncol 112:78–84PubMedCrossRef

14.

Small W Jr, Winter K, Levenback C et al (2007) Extended-field irradiation and intracavitary brachytherapy combined with cisplatin chemotherapy for cervical cancer with positive para-aortic or high common iliac lymph nodes: results of ARM 1 of RTOG 0116. Int J Radiat Oncol Biol Phys 68:1081–1087PubMedCrossRef

15.

Ring KL, Young JL, Dunlap NE et al (2009) Extended-field radiation therapy with whole pelvis radiotherapy and cisplatin chemosensitization in the treatment of IB2-IIIB cervical carcinoma: a retrospective review. Am J Obstet Gynecol 201:109.e1–109.e6

16.

Malfetano JH, Keys H (1991) Aggressive multimodality treatment for cervical cancer with paraaortic lymph node metastases. Gynecol Oncol 42:44–47PubMedCrossRef

17.

Malfetano JH, Keys H, Cunningham MJ et al (1997) Extended field radiation and cisplatin for stage IIB and IIIB cervical carcinoma. Gynecol Oncol 67:203–207PubMedCrossRef

18.

Kazumoto T, Kato S, Yokota G et al (2011) Is a low dose of concomitant chemotherapy with extended-field radiotherapy acceptable as an efficient treatment for cervical cancer patients with metastases to the para-aortic lymph nodes? Int J Gynecol Cancer 21:1465–1471PubMedCrossRef

19.

Christopherson WA, Buchsbaum HJ (1987) The influence of pretreatment celiotomy and para-aortic lymphadenectomy on the management of advanced stage squamous cell carcinoma of the cervix. Eur J Gynaecol Oncol 8:90–98PubMed

20.

Small W Jr, Mell LK, Anderson P et al (2008) Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy in postoperative treatment of endometrial and cervical cancer. Int J Radiat Oncol Biol Phys 71:428–434PubMedCentralPubMedCrossRef

21.

Taylor A, Rockall AG, Reznek RH et al (2005) Mapping pelvic lymph nodes: guidelines for delineation in intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys 63:1604–1612PubMedCrossRef

22.

Taylor A, Rockall AG, Powell ME (2007) An atlas of the pelvic lymph node regions to aid radiotherapy target volume definition. Clin Oncol (R Coll Radiol) 19:542–550CrossRef

23.

Toita T, Ohno T, Kaneyasu Y et al (2010) A consensus-based guideline defining the clinical target volume for pelvic lymph nodes in external beam radiotherapy for uterine cervical cancer. Jpn J Clin Oncol 40:456–463PubMedCrossRef

Titel: Feasibility of extended-field irradiation and intracavitary brachytherapy combined with weekly cisplatin chemosensitization for IB2–IIIB cervical cancer with positive paraaortic or high common iliac lymph nodes: a retrospective review
verfasst von: Shiho Kuji
Yasuyuki Hirashima
Satomi Komeda
Aki Tanaka
Masakazu Abe
Nobutaka Takahashi
Munetaka Takekuma
Hirofumi Asakura
Hideyuki Harada
Tetsuo Nishimura
Publikationsdatum: 01.04.2014
Verlag: Springer Japan
Erschienen in: International Journal of Clinical Oncology / Ausgabe 2/2014
Print ISSN: 1341-9625
Elektronische ISSN: 1437-7772
DOI: https://doi.org/10.1007/s10147-013-0551-8

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Feasibility of extended-field irradiation and intracavitary brachytherapy combined with weekly cisplatin chemosensitization for IB2–IIIB cervical cancer with positive paraaortic or high common iliac lymph nodes: a retrospective review