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

Christel N. Nomden, Richard Potter, Astrid A. C. de Leeuw, Kari Tanderup, Jacob Lindegaard, Maximilian P. Schmid, Israel Fortin, Christine Haie-Meder, Umesh Mahantshetty, Peter Hoskin, Barbara Segedin, Kjersti Bruheim, Bhavana Rai, Fleur Huang, Rachel Cooper, Elzbieta Van der Steen Banasik, Erik Van Limbergen, Ina M. Jurgenliemk-Schulz*, Isabelle Dumas, Cyrus ChargariLars Fokdal, Christian Kirisits, Alina Sturdza, Jamema Swamidas, Shyam Kishore Shrivastava, Gerry Lowe, Astrid De Leeuw, Barbara Segedin, Robert Hudej, Taran Paulsen Hellebust, Geetha Menon, Arun S. Oinam, Peter Bownes, Marit Sundset, Bradley Pieters, Li Tee Tan, Remi A. Nout, Ludy C. H. W. Lutgens, Elena Villafranca, Janaki Hadjiev, Francois Bachand, EMBRACE Collaborative Grp

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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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. (C) 2019 The Authors. Published by Elsevier B.V.

Original languageEnglish
Pages (from-to)185-190
Number of pages6
JournalRadiotherapy and Oncology
Publication statusPublished - May 2019


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

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