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Is extended-field concurrent chemoradiation an option for radiologic negative paraaortic lymph node, locally advanced cervical cancer?

Authors Al Asiri M, Tunio M, Mohamed R, Bayoumi Y, Alhadab A, Saleh RM, AlArifi M, Alobaid A, Abdulmoniem R

Received 23 May 2014

Accepted for publication 27 June 2014

Published 9 September 2014 Volume 2014:6 Pages 339—348


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Mushabbab Al Asiri,1 Mutahir A Tunio,1 Reham Mohamed,2 Yasser Bayoumi,2 Abdulrehman Alhadab,1 Rasha M Saleh,3 Muhannad Saud AlArifi,1 Abdelaziz Alobaid4

1Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia; 2Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt; 3Medical Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia; 4Women's Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia

Background: The aim was to evaluate whether extended-field concurrent chemoradiation (EF-CCRT) leads to results better than those obtained by standard whole-pelvis concurrent chemoradiation (WP-CCRT) in locally advanced cervical cancer with radiologic negative paraaortic lymph nodes (PALNs).
Patients and methods: A total of 102 patients with histopathologically proven squamous cell carcinoma, adenocarcinoma, or adenosquamous cell carcinoma, and radiologic negative PALN locally advanced cervical cancer, stage IIB-IVA, were accrued between July 2007 and April 2008 and were randomly assigned to WP-CCRT (50 patients) or EF-CCRT (52 patients), followed by high-dose rate brachytherapy. Data regarding the safety profile, response rates, and occurrence of local, PALN, or distant failure were recorded.
Results: During a median follow-up time of 60 months (18–66), 74/102 patients completed the treatment protocol and were analyzed. Overall PALN, distant-metastasis control, disease-free survival, and overall survival rates were 97.1%, 86.9%, 80.3%, and 72.4% in EF-CCRT respectively in comparison with WP-CCRT (82.1%,74.7%, 69.1%, and 60.4%), with P-values of 0.02, 0.03, 0.03 and 0.04 respectively. No difference in acute toxicity profile was seen between the groups, and late toxicities were mild and minimal.
Conclusion: Prophylactic EF-CCRT can be a reasonable option in patients with locally advanced cervical cancer with radiologic positive pelvic lymph nodes and radiologic negative PALN.

Keywords: prophylactic extended field radiation therapy, concurrent chemotherapy

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