Xiaojuan Lv1,2, Huiting Rao1,3, Tao Feng1,3, Chufan Wu1,3, Hanmei Lou4,5,6. 1. Department of Gynecologic Radiation Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Banshan East Road 1, Hangzhou, 310022, Zhejiang, China. 2. Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Banshan East Road 1, Hangzhou, 310022, Zhejiang, China. 3. The Second Affiliated College of Zhejiang Chinese Medical University, Zhejiang Chinese Medical University, Binwen Road 548, Hangzhou, 310053, Zhejiang, China. 4. Department of Gynecologic Radiation Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Banshan East Road 1, Hangzhou, 310022, Zhejiang, China. louhm@zjcc.org.cn. 5. Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Banshan East Road 1, Hangzhou, 310022, Zhejiang, China. louhm@zjcc.org.cn. 6. The Second Affiliated College of Zhejiang Chinese Medical University, Zhejiang Chinese Medical University, Binwen Road 548, Hangzhou, 310053, Zhejiang, China. louhm@zjcc.org.cn.
Abstract
BACKGROUND AND PURPOSE: Dose escalation for positive node maybe improve the regional control of patients with node-positive cervical cancer, but the optimal dose for nodes of different sizes remains controversial. The purpose of this study was to explore the individualized dose escalation for lymph nodes (LNs) with different sizes in the definitive radiotherapy of cervical cancer. METHODS: A total of 1002 cervical cancer patients with the International Federation of Gynecology and Obstetrics (FIGO 2009) stage IB1-IVA, who were treated by definitively radiotherapy between September 2013 and December 2016 were enrolled. All LNs identified by computed tomography/magnetic resonance imaging (CT/MRI) were assigned into three groups according to the short diameters of < 1 cm, 1-2 cm or ≥ 2 cm at pretreatment. RESULTS: In total, 580 patients with 1310 LNs were detected. The nodal control rate in groups of LNs < 1 cm, 1-2 cm and ≥ 2 cm was 99.4%, 96%, and 75.9%, respectively (P = 0.000). Among LNs < 1 cm, the control, overall survival (OS) and progression-free survival (PFS) rates did not significantly differ among three dose-based groups (≤ 50.4 Gy, 50.4-60 Gy, > 60 Gy) (control rate, 99.4% vs. 99.3% vs. 100%, P = 0.647) (5-year OS, 76.2% vs. 79% vs. 81.6%, P = 0.682) (5-year PFS, 74.1% vs. 73.9% vs. 78.9% P = 0.713). Among LNs of 1-2 cm, the control and PFS rates were significantly higher in the group of dose ≥ 55 Gy than the group of dose < 55 Gy (control rate, 98% vs. 93.6%, P = 0.028) (5-year PFS, 69.6% vs. 56.7%, P = 0.025). However, this did not cause a significant difference for 5-year OS rate (72.6% vs. 68.3%, P = 0.5). Among LNs ≥ 2 cm, the control, OS, and PFS rates were higher in the group of dose ≥ 55 Gy than the group of dose < 55 Gy, while no significant difference was found (control rate, 82.1% vs. 63.2%, P = 0.107) (5-year OS, 60.6% vs. 37.5%, P = 0.141) (5-year PFS, 51.5% vs.37.5%, P = 0.232). CONCLUSIONS: Radiation dose escalation is not necessary for LNs < 1 cm, and dose escalation of 55 Gy is enough for LNs of 1-2 cm.
BACKGROUND AND PURPOSE: Dose escalation for positive node maybe improve the regional control of patients with node-positive cervical cancer, but the optimal dose for nodes of different sizes remains controversial. The purpose of this study was to explore the individualized dose escalation for lymph nodes (LNs) with different sizes in the definitive radiotherapy of cervical cancer. METHODS: A total of 1002 cervical cancer patients with the International Federation of Gynecology and Obstetrics (FIGO 2009) stage IB1-IVA, who were treated by definitively radiotherapy between September 2013 and December 2016 were enrolled. All LNs identified by computed tomography/magnetic resonance imaging (CT/MRI) were assigned into three groups according to the short diameters of < 1 cm, 1-2 cm or ≥ 2 cm at pretreatment. RESULTS: In total, 580 patients with 1310 LNs were detected. The nodal control rate in groups of LNs < 1 cm, 1-2 cm and ≥ 2 cm was 99.4%, 96%, and 75.9%, respectively (P = 0.000). Among LNs < 1 cm, the control, overall survival (OS) and progression-free survival (PFS) rates did not significantly differ among three dose-based groups (≤ 50.4 Gy, 50.4-60 Gy, > 60 Gy) (control rate, 99.4% vs. 99.3% vs. 100%, P = 0.647) (5-year OS, 76.2% vs. 79% vs. 81.6%, P = 0.682) (5-year PFS, 74.1% vs. 73.9% vs. 78.9% P = 0.713). Among LNs of 1-2 cm, the control and PFS rates were significantly higher in the group of dose ≥ 55 Gy than the group of dose < 55 Gy (control rate, 98% vs. 93.6%, P = 0.028) (5-year PFS, 69.6% vs. 56.7%, P = 0.025). However, this did not cause a significant difference for 5-year OS rate (72.6% vs. 68.3%, P = 0.5). Among LNs ≥ 2 cm, the control, OS, and PFS rates were higher in the group of dose ≥ 55 Gy than the group of dose < 55 Gy, while no significant difference was found (control rate, 82.1% vs. 63.2%, P = 0.107) (5-year OS, 60.6% vs. 37.5%, P = 0.141) (5-year PFS, 51.5% vs.37.5%, P = 0.232). CONCLUSIONS: Radiation dose escalation is not necessary for LNs < 1 cm, and dose escalation of 55 Gy is enough for LNs of 1-2 cm.
Authors: Dominique L Rash; Yongsook C Lee; Amir Kashefi; Blythe Durbin-Johnson; Mathew Mathai; Richard Valicenti; Jyoti S Mayadev Journal: Int J Radiat Oncol Biol Phys Date: 2013-07-29 Impact factor: 7.038
Authors: Jeanny Kwon; Keun-Young Eom; Young Seok Kim; Won Park; Mison Chun; Jihae Lee; Yong Bae Kim; Won Sup Yoon; Jin Hee Kim; Jin Hwa Choi; Sei Kyung Chang; Bae Kwon Jeong; Seok Ho Lee; Jihye Cha Journal: Cancer Res Treat Date: 2017-10-24 Impact factor: 4.679