TY - JOUR
T1 - Nodal failure after chemo-radiation and MRI guided brachytherapy in cervical cancer
T2 - Patterns of failure in the EMBRACE study cohort
AU - Nomden, Christel N.
AU - Potter, Richard
AU - de Leeuw, Astrid A. C.
AU - Tanderup, Kari
AU - Lindegaard, Jacob
AU - Schmid, Maximilian P.
AU - Fortin, Israel
AU - Haie-Meder, Christine
AU - Mahantshetty, Umesh
AU - Hoskin, Peter
AU - Segedin, Barbara
AU - Bruheim, Kjersti
AU - Rai, Bhavana
AU - Huang, Fleur
AU - Cooper, Rachel
AU - Banasik, Elzbieta Van der Steen
AU - Van Limbergen, Erik
AU - Jurgenliemk-Schulz, Ina M.
AU - Dumas, Isabelle
AU - Chargari, Cyrus
AU - Fokdal, Lars
AU - Kirisits, Christian
AU - Sturdza, Alina
AU - Swamidas, Jamema
AU - Shrivastava, Shyam Kishore
AU - Lowe, Gerry
AU - De Leeuw, Astrid
AU - Segedin, Barbara
AU - Hudej, Robert
AU - Hellebust, Taran Paulsen
AU - Menon, Geetha
AU - Oinam, Arun S.
AU - Bownes, Peter
AU - Sundset, Marit
AU - Pieters, Bradley
AU - Tan, Li Tee
AU - Nout, Remi A.
AU - Lutgens, Ludy C. H. W.
AU - Villafranca, Elena
AU - Hadjiev, Janaki
AU - Bachand, Francois
AU - EMBRACE Collaborative Grp
N1 - Funding Information:
The EMBRACE study was supported by Elekta and Varian Medical System through unrestricted research grants and study sponsoring through Medical University of Vienna . Furthermore, research grants from the Danish Cancer Society , and the Danish Cancer Research Foundation supported this work. The financial support by the Austrian Federal Ministry for Digital and Economic Affairs and the National Foundation for Research, Technology and Development is gratefully acknowledged.
Funding Information:
The EMBRACE study was supported by Elekta and Varian Medical System through unrestricted research grants and study sponsoring through Medical University of Vienna. Furthermore, research grants from the Danish Cancer Society, and the Danish Cancer Research Foundation supported this work. The financial support by the Austrian Federal Ministry for Digital and Economic Affairs and the National Foundation for Research, Technology and Development is gratefully acknowledged.
Publisher Copyright:
© 2019 The Authors
PY - 2019/5
Y1 - 2019/5
N2 - 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.
AB - 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.
KW - Cervix cancer
KW - Lymph nodes metastases
KW - Nodal boost
KW - Nodal failure
KW - Para-aortic
KW - Pelvis
KW - DOSE-RATE BRACHYTHERAPY
KW - ADAPTIVE BRACHYTHERAPY
KW - CLINICAL IMPACT
KW - STAGE IIB
KW - RADIOTHERAPY
KW - SURVIVAL
KW - CHEMORADIOTHERAPY
KW - MORBIDITY
U2 - 10.1016/j.radonc.2019.02.007
DO - 10.1016/j.radonc.2019.02.007
M3 - Article
C2 - 31005214
SN - 0167-8140
VL - 134
SP - 185
EP - 190
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
ER -