The Efficacy And Prognosis Of Intensity-modulated Radiotherapy In Cervical Cancer Patients With Regional Lymph Node Metastasis

Part? Extended-field intensity-modulated radiation therapy combined with concurrent chemotherapy for cervical cancer with para-aortic lymph nodes metastasisObjective: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%,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.Part ? Intensity-modulated radiotherapy in patients with FIGO ?C1 cervical cancer:efficacy,toxicity and prognosisObjective:To investigate the efficacy,toxicity and prognosis of image-guided intensity-modulated radiotherapy(IMRT)in patients with FIGO ?C1 cervical cancer.Methods:We retrospectively reviewed clinical records of patients with FIGO ?C1 cervical cancer treated with definitive IG-IMRT in our institute from January 2008 to December 2017.A dose of 50.4Gy in 28 fractions was prescribed to at least 95%of PCTV,the positive pelvic lymph nodes received a dose of 56-61.6Gy in 28 fractions with simultaneous integrated boost(SIB).Weekly cone beam compute tomography(CBCT)and daily megavoltage CT(MVCT)was performed before treatment.Both 2D brachytherapy and 3D brachytherapy were allowed in our study.Weekly Cisplatin(30-40mg/m2)was the first line regimen for concurrent chemotherapy.Overall survival(OS),disease free survival(DFS),local control(LC)and local regional control(LRC)was calculated with Kaplan-Meier method.Cox proportional hazard model was used to perform univariate and multivariate analysesResults:A total of 502 patients were enrolled in this study.The median follow-up duration was 42.1 months(range:2.3-137.3 months).The 3-year and 5-year estimated OS,DFS,LC,LRC were 81.7%and 75.5%,71.4%and 68.6%,89.9%and 89.9%,86.1%and 84.3%,respectively.The incidences of chronic grade 3 or greater gastrointestinal and genitourinary toxicities were 2.7%and 0.8%,respectively.Pelvic lymph nodes recurrence occurred in 25 patients(5.0%).Advanced T stage was identified as adverse factor for OS and LC.More positive lymph nodes(?2)were associated with worse OS,DFS and LRC.The cycles of concurrent chemotherapy significantly affected OS,DFS and LRC.Conclusion:For patients with FIGO ?C1 cervical cancer,IG-IMRT was well tolerated with excellent survivals.T stage and number of positive lymph nodes significantly influenced the survivals indicating the heterogeneity of stage ?C1 patients.Adequate cycles of chemotherapy(?4 cycles)was of great value for this group of patients.Part ? Risk factors of lymph node recurrence in patients with FIGO ?C cervical cancer-based on characteristics of single lymph nodeObjective:To investigate the risk factors of lymph node recurrence in FIGO ?C cervical cancer patients receiving definitive chemoradiotherapy.Methods:We retrospectively reviewed clinical records of cervical cancer patients receiving definitive CCRT at our institution between November 2012 and December 2017,The basic characteristics of positive lymph nodes and treatment related factors were mainly collected.All positive LNs were prescribed to 56-61.6Gy/28F with SIB.Chi-square test and logistic regression model were used to identify risk factors of LN recurrence.ROC curves were performed to identify the optimal cut-off values of continuous variables.A two-side P<0.05 was defined as statistically significant.Results:A total of 167 patients were enrolled in this study.380 LNs were identified as metastasis including 315 pelvic LNs and 65 para-aortic LNs.For total LNs,the incidence of LN recurrence was 8.9%(34/380).For pelvic and para-aortic LNs,the LN recurrence rates were 7.6%and 15.4%(P=0.046),respectively.The diameter of LN after 20 fractions of RT(R20F),ratio of nodal reduction after 20 fractions of RT(?V20F)and cycles of chemotherapy were significantly associated with LN recurrence for total LNs.For pelvic LNs,?V20F<0.435 and<4 cycles of chemotherapy were related to high incidence of LN failure.For para-aortic LNs,only ?V20F<0.435 was risk factors for LN recurrence.Conclusion:Compared with pelvic lymph nodes,para-aortic lymph nodes were more likely to suffer recurrence.?V20F<0.435 indicated worse prognosis for positive lymph nodes.Adequate cycles of chemotherapy(?4 cycles)was important in preventing nodal recurrence.