Choi, Kyu Hye; Kim, Ji Yoon; Lee, Dong Soo; Lee, Yun Hee; Lee, Sea-Won; Sung, SooYoon; Park, Hee Hyun; Yoon, Sei-Chul; Hur, Soo Young; Park, Jong-Sup; Kim, Yeon Sil
Medicine
2018Apr ; 97 ( 16 ) :e0517.
PMID : 29668638
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Choi, Kyu Hye - Department of Radiation Oncology, Seoul St. Mary's Hospital.
Kim, Ji Yoon - Department of Radiation Oncology, Seoul St. Mary's Hospital.
Lee, Dong Soo - Department of Radiation Oncology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul.
Lee, Yun Hee - Department of Radiation Oncology, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju-si, Gyeongsangnam-do.
Lee, Sea-Won - Department of Radiation Oncology, Seoul St. Mary's Hospital.
Sung, SooYoon - Department of Radiation Oncology, Seoul St. Mary's Hospital.
Park, Hee Hyun - Department of Radiation Oncology, Seoul St. Mary's Hospital.
Yoon, Sei-Chul - Department of Radiation Oncology, Bucheon St. Mary's Hospital.
Hur, Soo Young - Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Park, Jong-Sup - Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Kim, Yeon Sil - Department of Radiation Oncology, Seoul St. Mary's Hospital.
ABSTRACT
The aim of this study was to analyze tumor control and clinical outcomes of patients with uterine cervical cancer treated by chemoradiotherapy according to pelvic lymph node (PLN) positivity and boost irradiation to PLN and to determine toxicities associated with boost irradiation.We retrospectively reviewed patients with uterine cervical cancer treated with chemoradiotherapy between March 2000 and April 2015. Clinical characteristics, failure pattern, and survival outcomes of patients with or without PLN metastasis and those with or without boost irradiation were analyzed.A total of 80 cases were PLN-negative and 46 were PLN-positive. A total of 11 patients underwent PLN boost irradiation. The 2-year and 5-year overall survival (OS) rates showed significant difference between the PLN-positive and PLN-negative groups (P?=?.010). The 2-year and 5-year progression-free survival (PFS) rates showed significant difference between the 2 groups (P?=?.032). The 2-year and 5-year OS rates of the no-boost irradiation group were 82.9% and 58.3%, respectively, whereas all patients in the boost irradiation group were alive at the time of analysis (P?=?.065). There was no recurrence in the boost irradiation group. The difference in PFS was significant between the boost and the no-boost irradiation groups (P?=?.023). The 2-year and 5-year pelvic-recurrence free survival (PRFS) did not show significant difference but the tendency of increased risk of pelvic recurrence in no-boost group (boost vs no-boost; 81.9% and 70.2% vs 100% and 100% in 2-year and 5-year PRFS, respectively, P?=?.156). Boost irradiation to PLN could improve locoregional control especially in large pelvic LN (??.5?cm). Our results showed that only 1 acute and late toxicity of higher than grade 3 occurred.PLN metastasis was significant prognostic factor in cervix cancer treated by chemoradiotherapy. In the boost irradiation group, there was no recurrence or death with significantly better PFS. Boost irradiation to PLN is expected to improve locoregional control, but further follow-up and assessment are needed.
boost irradiation, cervix cancer, chemoradiotherapy, pelvic lymph node, radiotherapy dosage
MESH
Brachytherapy/*methods, Chemoradiotherapy/*methods, Chemotherapy, Adjuvant/methods, Cisplatin/*administration & dosage, Disease-Free Survival, Etoposide/*administration & dosage, Female, Humans, *Lymph Nodes/pathology/radiation effects, *Lymphatic Metastasis/pathology/prevention & control/radiotherapy, Middle Aged, Neoplasm Recurrence, Local/diagnosis/prevention & control, Outcome and Process Assessment (Health Care), Pelvis, Radiotherapy Dosage, Republic of Korea/epidemiology, *Uterine Cervical Neoplasms/drug therapy/mortality/pathology/radiotherapy
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