Research status of prophylactic irradiation to para-aortic lymph nodes in cervical cancer
Liu Yehong, Guo Qi, Tian Ye
Department of Radiotherapy Oncology, The Second Affiliated Hospital of Soochow University, Institute of Radiotherapy Oncology, Soochow University, Suzhou Key Laboratory for Radiation Oncology, Suzhou 215004, China
Abstract：The recurrence rate of para-aortic lymph nodes in patients with cervical cancer undergoing concurrent pelvic chemoradiotherapy is approximately 10%,which seriously affects the prognosis of patients with cervical cancer. Some researchers suggest that high-risk patients with locally advanced cervical cancer undergo prophylactic irradiation to the para-aortic lymph nodes based on pelvic chemoradiotherapy. In this article, the clinical efficacy, the applicable population, the upper margin of the target volume, the preventive dose and the side effects of prophylactic irradiation to the para-aortic lymphatic nodes were analyzed.
Liu Yehong,Guo Qi,Tian Ye. Research status of prophylactic irradiation to para-aortic lymph nodes in cervical cancer[J]. Chinese Journal of Radiation Oncology, 2019, 28(2): 146-150.
[1] Gunderson LL,Tepper JE.Clinical radiation oncology[M].4th ed. Amsterdam:Elsevier,2016:1173-1202. [2] National comprehensive cancer network (NCCN).Clinical practice guidelines in oncology. Cervical Cancer,Version 1.2018[DB/OL][20180-04-09].https://www.nccn.org/professionals/physician_gls/pdf/cervical.pdf. [3] Marth C,Landoni F,Mahner S,et al. Cervical cancer:ESMO clinical practice guidelines for diagnosis,treatment and follow-up[J].Ann Oncol,2017,28(Suppl 4):iv72-iv83.DOI:10.1093/annonc/mdx220. [4] Eifel PJ,Winter K,Morris M,et al. Pelvic irradiation with concurrent chemotherapy versus pelvic and para-aortic irradiation for high-risk cervical cancer:an update of radiation therapy oncology group trial (RTOG) 90-01[J].J Clin Oncol,2004,22(5):872-880.DOI:10.1200/JCO.2004.07.197. [5] Lin SY,Tsai CS,Chang YC,et al. The role of pretreatment FDG-PET in treating cervical cancer patients with Enlarged pelvic lymph node (s) shown on MRI:a phase 3 randomized trial with long-term follow-up[J].Int J Radiat Oncol Biol Phys,2015,92(3):577-585.DOI:10.1016/j.ijrobp.2015.02.027. [6] Ribeiro I,Janssen H,De BM,et al. Long term experience with 3D image guided brachytherapy and clinical outcome in cervical cancer patients[J].Radiother Oncol,2016,120(3):447-454.DOI:10.1016/j.radonc.2016.04.016. [7] Halperin EC,Wazer DE,Perez CA,et al. Perez& Brady′s principles and practice of radiation oncology[M].6th ed. Philadelphia:Lippincott Williams& Wilkins,2013. [8] Sapienza LG,Gomes MJL,Calsavara VF,et al. Does para-aortic irradiation reduce the risk of distant metastasis in advanced cervical cancer? A systematic review and meta-analysis of randomized clinical trials[J].Gynecol Oncol,2016,144(2):312-317.DOI:10.1016/j.ygyno.2016.11.044. [9] Yap M L,Cuartero J,Yan J,et al. The role of elective para-aortic lymph node irradiation in patients with locally advanced cervical cancer.[J].Clin Oncol (R Coll Radiol),2014,26(12):797-803.DOI:10.1016/j.clon.2014.08.008. [10] Park SG,Jin HK,Oh YK,et al. Is Prophylactic irradiation to para-aortic lymph nodes in locally advanced cervical cancer necessary?[J].Cancer Res Treat,2014,46(4):374-382.DOI:10.4143/crt.2013.084. [11] Lee J,Lin JB,Chang CL,et al. Prophylactic lower para-aortic irradiation using intensity-modulated radiotherapy mitigates the risk of para-aortic recurrence in locally advanced cervical cancer:a 10-year institutional experience[J].Gynecol Oncol,2017,146(1):20-26.DOI:10.1016/j.ygyno.2017.04.016. [12] Liang JA,Chen SW,Hung YC,et al. Low-dose,prophylactic,extended-field,intensity-modulated radiotherapy plus concurrent weekly cisplatin for patients with stage ⅠB2-ⅢB cervical cancer,positive pelvic lymph nodes,and negative para-aortic lymph nodes[J].Int J Gynecol Cancer,2014,24(5):901-907.DOI:10.1097/IGC.0b013e31829f4 dc5. [13] Asiri MA,Tunio MA,Mohamed R,et al. Is extended-field concurrent chemoradiation an option for radiologic negative paraaortic lymph node,Locally advanced cervical cancer?[J].Cancer Manag Res,2014,6(1):339-48.DOI:10.2147/CMAR.S68262. [14] Malfetano JH,Keys H,Cunningham MJ,et al. Extended field radiation and cisplatin for stage ⅡB and ⅢB cervical carcinoma[J].Gynecol Oncol,1997,67(2):203-207. [15] Choi J,Yoon HI,Lee J,et al. Optimal extent of prophylactic irradiation of paraaortic lymph nodes in patients with uterine cervical cancer[J].Plos One,2015,10(12):e0145158.DOI:10.1371/journal.pone.0145158. [16] 刘晓亮.宫颈癌延伸野调强放疗的临床研究[D].北京协和医学院,2016. Liu XL.Clinical study of extended field intensity modulated radiotherapy for cervical cancer[D]. Peking Union Medical College,2016. [17] Kim JH,Kim JY,Yoon MS,et al. Prophylactic irradiation of para-aortic lymph nodes for patients with locally advanced cervical cancers with and without high CA9 expression (KROG 07-01):a randomized,open-label,multicenter,phase 2 trial[J].Radiother Oncol,2016,120(3):383-389. [18] Lee J,Lin JB,Chang CL,et al. Impact of para-aortic recurrence risk-guided intensity-modulated radiotherapy in locally advanced cervical cancer with positive pelvic lymph nodes[J].Gynecol Oncol,2017,148(2):291-298.DOI:10.1016/j.ygyno.2017.12.003. [19] Huang H,Liu J,Li Y,et al. Metastasis to deep obturator and para-aortic lymph nodes in 649 patients with cervical carcinoma.[J].Eur J Surg Oncol,2011,37(11):978-983.DOI:10.1016/j.ejso.2011.08.128. [20] Yuuki K,Naoya M,Madoka M,et al. Impact of concurrent chemotherapy on definitive radiotherapy for women with FIGO Ⅲ b cervical cancer[J].J Radiat Res,2012,53(4):588-593.DOI:10.1093/jrr/rrs010. [21] Mabuchi S,Ugaki H,Isohashi F,et al. Concurrent weekly nedaplatin,external beam radiotherapy and high-dose-rate brachytherapy in patients with FIGO stage Ⅲ b cervical cancer:a comparison with a cohort treated by radiotherapy alone[J].Gynecol Obstet Invest,2010,69(4):224-232.DOI:10.1159/000273207. [22] Chai Y,Wang T,Wang J,et al. Radical hysterectomy with adjuvant radiotherapy versus radical radiotherapy for FIGO stage ⅡB cervical cancer[J].BMC Cancer,2014,14(1):63.DOI:10.1186/1471-2407-14-63. [23] Wang N,Li WW,Li JP,et al. Comparison of concurrent chemoradiotherapy followed by radical surgery and high-dose-rate intracavitary brachytherapy:a retrospective study of 240 patients with FIGO stage ⅡB cervical carcinoma[J].Oncol Targ Ther,2014,7(1):91-100.DOI:10.2147/OTT.S52710. [24] Chen CC,Wang L,Lin J C,et al. The prognostic factors for locally advanced cervical cancer patients treated by intensity-modulated radiation therapy with concurrent chemotherapy[J].J Formos Med Assoc,2015,114(3):231-237.DOI:10.1016/j.jfma.2012.10.021. [25] 刘树伟,李瑞锡.局部解剖学[M].北京:人民卫生出版社,2013:147-150. Liu SW,Li RX.Local anatomy[M].Beijing:People′s health press,2013:147-150. [26] Liu Z,Hu K,Liu A,et al. Patterns of lymph node metastasis in locally advanced cervical cancer[J].Medicine,2016,95(39):e4814.DOI:10.1097/MD.0000000000004814. [27] Pomel C,Naik R,Martinez A,et al. Systematic (complete) para-aortic lymphadenectomy:description of a novel surgical classification with technical and anatomical considerations[J].BJOG,2012,119(2):249-253.DOI:10.1111/j.1471-0528.2011.03171.x. [28] Ouldamer L,Fichet-Djavadian S,Marret H,et al. Upper margin of para-aortic lymphadenectomy in cervical cancer[J].Acta Obstet Gynecol Scand,2012,91(8):893-900.DOI:10.1111/j.1600-0412.2012.01443.x. [29] Keenan LG,Rock K,Azmi A,et al. An atlas to aid delineation of para-aortic lymph node region in cervical cancer:design and validation of contouring guidelines[J].Radiother Oncol,2018,49(1-2):65-85.DOI:10.1016/j.radonc.2018.02.013. [30] Beadle BM,Jhingran A,Yom SS,et al. Patterns of regional recurrence after definitive radiotherapy for cervical cancer[J].Int J Radiat Oncol Biol Phys,2010,76(5):1396-1403.DOI:10.1016/j.ijrobp.2009.04.009. [31] Gouy S,Morice P,Narducci F,et al. Nodal-staging surgery for locally advanced cervical cancer in the era of PET[J].Lancet Oncol,2012,13(5):e212-220.DOI:10.1016/S1470-2045(12)70011-6. [32] Ouyang Y,Wang Y,Chen K,et al. Clinical outcome of extended-field irradiation vs.pelvic irradiation using intensity-modulated radiotherapy for cervical cancer[J].Oncol Lett,2017,14(6):7069-7076.DOI:10.3892/ol.2017.7077. [33] Marnitz S,Wlodarczyk W,Neumann O,et al. Which technique for radiation is most beneficial for patients with locally advanced cervical cancer? Intensity modulated proton therapy versus intensity modulated photon treatment,helical tomotherapy and volumetric arc therapy for primary radiation-an intraindividual comparison[J].Radiat Oncol,2015,10(1):91.DOI:10.1186/s13014-015-0402-z. [34] Yang B,Zhu L,Cheng H,et al. Dosimetric comparison of intensity modulated radiotherapy and three-dimensional conformal radiotherapy in patients with gynecologic malignancies:a systematic review and meta-analysis[J].Radiat Oncol,2012,7(1):197.DOI:10.1186/1748-717X-7-197. [35] Gandhi AK,Sharma DN,Rath GK,et al. Early clinical outcomes and toxicity of intensity modulated versus conventional pelvic radiation therapy for locally advanced cervix carcinoma:a prospective randomized study[J].Int J Radiat Oncol Biol Phys,2013,87(3):542-548.DOI:10.1016/j.ijrobp.2013.06.2059.
2019, Vol. 28 
