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Radiother Oncol. 2019 May;134:185-190. doi: 10.1016/j.radonc.2019.02.007. Epub 2019 Feb 26.

Nodal failure after chemo-radiation and MRI guided brachytherapy in cervical cancer: Patterns of failure in the EMBRACE study cohort.

Author information

1
Department of Radiation Oncology, University Medical Center Utrecht, the Netherlands.
2
Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria.
3
Department of Oncology, Aarhus University Hospital, Denmark.
4
Department of Radiation Oncology, Gustave Roussy, Villejuif, France.
5
Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Homi Bhabha National Institute (HBNI), India.
6
Cancer Centre, Mount Vernon Hospital, Northwood, United Kingdom.
7
Department of Radiotherapy, Institute of Oncology, Ljubljana, Slovenia.
8
Department of Oncology, The Norwegian Radium Hospital, Oslo University Hospital, Norway.
9
Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
10
Department of Oncology, Cross Cancer Institute and University of Alberta, Edmonton, Canada.
11
Leeds Cancer Centre, St James's University Hospital, United Kingdom.
12
Department of Radiotherapy, Arnhem, the Netherlands.
13
Department of Radiation Oncology, UZ Leuven, Belgium.
14
Department of Radiation Oncology, University Medical Center Utrecht, the Netherlands. Electronic address: I.M.Schulz@umcutrecht.nl.

Abstract

PURPOSE/OBJECTIVE(S):

To investigate the patterns of nodal failure in patients enrolled in the international multicentre EMBRACE study.

MATERIALS/METHODS:

Nodal disease at diagnosis (N-, N+) and nodal failure were analysed per region (NF) (pelvic (parametrial, common iliac, internal/external iliac), inguinal and para-aortic (PAO)) in 1338 patients. Treatment consisted of chemo-radiation and MRI guided brachytherapy. PAO radiotherapy and/or nodal boost was left to the treating centre. At time of diagnosis 52% of patients had pathologic nodes. Frequency analyses were performed in relation to patient, primary tumour and nodal disease characteristics, and treatment related factors.

RESULTS:

Median follow up was 34 months and 83% of NF occurred within 24 months. At diagnosis 99% of the N+ patients had pathologic nodes in the pelvis and 14% in the PAO. NFpelvic and NFPAO were reported in 55% and 68% of patients with NF, respectively. Overall NF was reported in 152 patients (11%); 7 and 16% for N- and N+ patients. Of the patients with NF, 41% were located outside the elective target (39% PAO), 40% inside and 35% inside the nodal boost target. Twelve percent of N+ patients that received a nodal boost had a NF inside the nodal boost target.

CONCLUSION:

Within the EMBRACE study cohort the overall number of patients developing nodal failure is low, significantly lower for N- compared to N+ patients. Pathological nodes at diagnosis are mainly located in the pelvis, whereas nodal failures are more often reported in the PAO region. About 40% of all nodal failures were reported outside the treatment targets.

KEYWORDS:

Cervix cancer; Lymph nodes metastases; Nodal boost; Nodal failure; Para-aortic; Pelvis

PMID:
31005214
DOI:
10.1016/j.radonc.2019.02.007
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