2866 - A Prospective Multicenter Study of Extended-Field Intensity-Modulated Radiation Therapy and High-Dose-Rate Brachytherapy with Concurrent Chemotherapy for Cervical Cancer with Positive Para-Aortic or Common Iliac Lymph Nodes
Presenter(s)
G. Wang1, J. MA2, F. Zhao3, L. C. Wei4, H. Zhu5, G. Cheng6, K. Zhao7, Y. Shi8, P. Wang9, J. He10, K. Gao11, W. Zhong12, F. Zhang2, and K. Hu1; 1Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China, 2Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China, 3Gansu provincal Cancer Hospital, Lanzhou, China, 4Department of Radiation Oncology, First Affiliated Hospital of Air Force Medical University, Xi'an, China, 5Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China, 6China-Japan Union Hospital of Jilin University, Changchun, China, 7Jilin Cancer Hospital, Changchun, China, 8Department of Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China, 9Department of Radiation Oncology, Tangshan People’s Hospital, Hebei, China, Tangshan, China, 101Department of Radiation Oncology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, China, Yinchuan, China, 11The Affilied Tumor Hospital of Guangxi Medical University, Guangxi, China, 12Gynaecological Oncology Radiotherapy, Affiliated Tumor Hospital, Xinjiang Medical University, Urumqi, P. R. China, Urumqi, China
Purpose/Objective(s): The purpose of this prospective, multicenter study was to evaluate the efficacy and safety of extended-field intensity-modulated radiation therapy (EF-IMRT) combined with concurrent chemotherapy and high-dose-rate (HDR) brachytherapy in patients with locally advanced cervical cancer and positive para-aortic or common iliac lymph node metastases.
Materials/Methods: Patients aged 18–75 years with biopsy-proven cervical cancer and confirmed para-aortic or common iliac lymph node metastases were enrolled from 11 hospitals in China. All patients were treated with EF-IMRT with concurrent chemotherapy followed by HDR brachytherapy. The PTV was prescribed a dose of 45 - 50.4Gy in 25 - 28 fractions, and the PGTVnd was boosted to a total dose of 55 – 66Gy. Additional parametrial boosts of 10Gy were delivered to patients with FIGO IIIB disease. HDR brachytherapy was prescribed at a dose of 28 - 36Gy to point A, using 2D or 3D design. The primary endpoint was progression-free survival (PFS), while secondary endpoints included overall survival (OS), local progression-free survival (LPFS), distant metastasis-free survival (DMFS), and adverse events.Toxicities were graded using the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0, with acute and chronic toxicities assessed.Kaplan-Meier survival curves were constructed, and subgroup comparisons were performed using the log-rank test.
Results: Between October 2015 and July 2018, 215 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB-IIIB cervical cancer were enrolled to the study of which 204 patients were evaluable for analysis, with a median follow-up of 68.7 months (range, 4.8–115.1 months). The study demonstrated that the 3-year and 5-year PFS rates were 68.3% and 64.6%, respectively, with OS rates of 76.4% and 69.5%. The 5-year LPFS and DMFS were 83.1% and 70.1%, respectively. Notably, patients with positive para-aortic lymph nodes exhibited significantly lower PFS, OS, LPFS, and DMFS compared to those with negative nodes (p < 0.05). Among the 111 patients with PALN involvement, 50 patients with positive common iliac lymph node had significantly lower PFS and DMFS compared to those with negative nodes (p < 0.05). Acute grade =3 gastrointestinal toxicities occurred in 16.7% of patients, with chronic grade =3 gastrointestinal toxicities observed in 3%. The treatment regimen was well tolerated overall.
Conclusion: This multicenter study provides evidence that EF-IMRT combined with concurrent chemotherapy and HDR brachytherapy offers promising efficacy and favorable local control for cervical cancer with positive para-aortic or common iliac lymph node metastases.