2738 - Prophylactic Extended-Field Irradiation vs. Pelvic Radiotherapy in Postoperative Cervical Cancer Patients with Pelvic Lymph Node-Positive
Presenter(s)
Y. Du1, F. Li1, J. Li2, L. Hu1, and F. Mei3; 1Department of Oncology, the Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China, 2Department of Gynecologic Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China, 3Department of Gynecologic Oncology, the Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, Guizhou Province, China
Purpose/Objective(s): Cervical cancer is one of the most common cancers among women, ranking fourth worldwide. Chemoradiotherapy is the primary treatment for cervical cancer patients with high-risk factors after surgery. Para-aortic lymph node metastasis and local recurrence are the main modes of treatment failure. Studies have shown that the rate of para-aortic lymph node metastasis is higher in patients with positive pelvic lymph nodes compared to those with negative pelvic lymph nodes. The aim of this study is to evaluate the efficacy of prophylactic extended-field pelvic radiotherapy(EF-PRT) and standard whole pelvic radiotherapy(WPRT) in postoperative patients with pelvic node-positive cervical cancer.
Materials/Methods: A total of 109 cases with cervical cancer with positive pelvic lymph nodes diagnosed by postoperative pathology from October 17, 2019 to September 8, 2023 were enrolled in this study. All patients received with Intensity Modulated Radiotherapy (IMRT) to a dose of 50.4Gy/28 fractions over five weeks. Concurrent chemotherapy with cisplatin 40mg/m2 weekly will be given during external beam radiotherapy in both the arms.
Results: Overall, A total of 109 patients were enrolled in this study, including 57 patients receiving postoperative pelvic field radiotherapy and 52 patients receiving prophylactic extended field radiotherapy. The median age was 49 years (range: 27-70 years), and the median time to completion of radiotherapy was 44 days. There were 81 patients with grade 0-1 gastrointestinal reactions, including 43 patients with pelvic radiation and 38 patients with extended radiation. There were 27 patients with grade 2-3 gastrointestinal reactions, including 14 patients with pelvic radiation and 13 patients with extended radiation. One patient had grade 4 gastrointestinal reactions, P=0.572. Comparison of hematological toxicity between extended field radiotherapy and pelvic field radiotherapy: Similarly, there was no significant difference in the effect on neutrophils and platelets between extended field radiotherapy and pelvic field radiotherapy.
Conclusion: In this study, prophylactic extended field radiotherapy for cervical cancer patients with pelvic lymph node metastasis after surgery does not increase gastrointestinal reactions and hematologic toxicity compared with pelvic field radiotherapy, and the toxic side effects are controllable. Whether it can reduce para-aortic lymph node metastasis and improve survival benefits still requires further exploration.