Analysis Of Lymph Node Control In Patients Treated With Whole-Pelvic Radiation And Intracavitary Brachytherapy Without Lymph Node Boost For Uterine Cervical Cancer

The current study was performed to evaluate the patterns of pelvic lymph node (PLN) failure and the rate of PLN control in patients treated with whole-pelvic irradiation (WPRT) without pelvic lymph node boost (LNB) in definitive concurrent chemoradiation therapy (CCRT) for cervical cancer. We reviewed the records of 101 patients with PLN-positive cervical cancer who were treated with cisplatin-based CCRT and intracavitary brachytherapy at our institution between March 2005 and December 2011. All PLNs were detected by positron emission tomography/computed tomography along with magnetic resonance image. WPRT was delivered at a dose of 50.4 Gy in 28 fractions and a LNB was not performed in all patients. Sites of PLN progressions were categorized as the initially involved PLN (iPLN, PLN initially positive at the time of diagnosis) and the new metastatic PLN (nPLN, PLN newly developed of metastasis within WPRT field after CCRT). The median follow-up time for all patients was 44 months (range, 6-107). The 101 patients had 232 metastatic PLN. The median short diameter of the PLN was 2.1cm (range, 1.0-6.6). A total of 13 PLN were progressed among 19 patients. For the sites of failure, 3 patients failed in iPLN, 5 in iPLN along with nPLN, and 11 in nPLN only. The 5-year PLN control rates of iPLN, nPLN, and all PLN were 93.7%, 81.1%, and 79.4%, respectively. The 5-year overall survival and disease free survival rates of the patients were 79.8% and 57.3%, respectively. In univariate and multivariate analyses showed that the level of pre-CCRT serum squamous carcinoma cell antigen (SCC Ag) and overall treatment time of radiation therapy (OTT) were significantly related to the iPLN control; the 5-year rates of iPLN progression in patients with SCC Ag ≥ 14 ng/mL and SCC Ag < 14 ng/mL were 11.6% and 3.4%, respectively (P=.01). The 5-year rate of iPLN progression in patients with OTT ≥ 51 days and OTT < 51 days were 12.3% and 0.0%, respectively (P=.03). After WPRT without LNB, nPLN failures were more frequently observed than iPLN progressions in patients treated with definitive CCRT for cervical cancer. The control rate of iPLN was favorable in patients with SCC Ag < 14 ng/mL, and OTT < 51 days.