Advances in the application of preventive extended-field radiotherapy to advanced cervical cancer
Jiang Meijing1, Li Yong2, Wang Mingxing1, Ge Xin1, Jin Hong1, Li Qi1
1Department of Gynecology and Radiology,Harbin Medical University Cancer Hospital, Harbin 150081,China; 2Department of Obstetrics and Gynecology, Karamay People's Hospital,Kelamayi 834000,China
Abstract：Cervical cancer is a common malignant tumor in gynecology, and its morbidity and mortality rates rank the fourth among female malignant tumors. Lymph node metastasis is the most important pattern of metastasis and a critical independent prognostic factor for cervical cancer. Considering the high missed diagnosis rate of para-aortic lymph node metastasis, and the high treatment failure rate caused by para-aortic lymph node metastasis after cervical cancer treatment,a small number of clinicians have applied preventive extended-field radiotherapy in the treatment of patients with ⅢB and Ⅲ c1 cervical cancer in recent years. This article reviews the prognosis and side effects of preventive extended-field radiotherapy in patients with stage ⅢB and Ⅲ c1 cervical cancer.
Jiang Meijing,Li Yong,Wang Mingxing et al. Advances in the application of preventive extended-field radiotherapy to advanced cervical cancer[J]. Chinese Journal of Radiation Oncology, 2022, 31(4): 400-403.
[1] Erratum:global cancer statistics 2018:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2020, 70(4):313. DOI:10.3322/caac.21609. [2] Arbyn M, Weiderpass E, Bruni L, et al. Estimates of incidence and mortality of cervical cancer in 2018:a worldwide analysis[J]. Lancet Glob Health, 2020, 8(2):e191-e203. DOI:10.1016/S2214-109X (19)30482-6. [3] Du R, Li L, Ma S, et al. Lymph nodes metastasis in cervical cancer:incidences, risk factors, consequences and imaging evaluations[J]. Asia Pac J Clin Oncol, 2018, 14(5):e380-e385. DOI:10.1111/ajco.12997. [4] 胡艳, 常晓斌, 王国庆, 等. 宫颈癌 538例预后影响因素分析[J]. 陕西医学杂志, 2017, 46(11):1531-1534. DOI:10.3969/j.issn.1000-7377.2017.11.013. Hu Y,Chang XB,Wang GQ,et al. Prognostic factor analysis of 538 cases of cervical cancer[J]. Shaanxi Med J,2017,46(11):1531-1534. DOI:10.3969/j.issn.1000-7377.2017.11.013. [5] Ayhan A, Aslan K,ÖzM,et al. Para-aortic lymph node involvement revisited in the light of the revised 2018 FIGO staging system for cervical cancer[J]. Arch Gynecol Obstet, 2019, 300(3):675-682. DOI:10.1007/s00404-019-05232-7. [6] Tsuruga T, Fujimoto A, Kawana K, et al. Radical hysterectomy with or without para-aortic lymphadenectomy for patients with stage b2, ⅡA2, and ⅡB cervical cancer:outcomes for a series of 308 patients[J]. Int J Clin Oncol, 2016, 21(2):359-366. DOI:10.1007/s10147-015-0907-3. [7] Thamronganantasakul K, Supakalin N, Kietpeerakool C, et al. Extended-field radiotherapy for locally advanced cervical cancer[J]. Cochrane Database Syst Rev, 2018, 10(10):CD012301. DOI:10.1002/14651858.CD012301.pub2. [8] Wang W, Wang D, Liu X, et al. Risk factors associated with para-aortic lymph node failure after pelvic irradiation in patients with cervical cancer[J]. J Cancer, 2020, 11(17):5099-5105. DOI:10.7150/jca.45520. [9] Ring KL, Young JL, Dunlap NE, et al. Extended-field radiation therapy with whole pelvis radiotherapy and cisplatin chemosensitization in the treatment of Ib2-ⅢB cervical carcinoma:a retrospective review[J]. Am J Obstet Gynecol, 2009, 201(1):109.e1-6. DOI:10.1016/j.ajog.2009.03.022. [10] Wang W, Zhou Y, Wang D, et al. Prophylactic extended-field irradiation in patients with cervical cancer:A literature review[J]. Front Oncol, 2020, 10:579410. DOI:10.3389/fonc.2020.579410. [11] Lee J, Lin JB, Sun FJ, et al. Safety and efficacy of semiextended field intensity-modulated radiation therapy and concurrent cisplatin in locally advanced cervical cancer patients:an observational study of 10-year experience[J]. Medicine (Baltimore), 2017, 96(10):e6158. DOI:10.1097/MD.0000000000006158. [12] 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, 2018, 148(2):291-298. DOI:10.1016/j.ygyno.2017.12.003. [13] Rotman M, Pajak TF, Choi K, et al. Prophylactic extended-field irradiation of para-aortic lymph nodes in stages ⅡB and bulky IB and ⅡA cervical carcinomas. ten-year treatment results of RTOG 79-20[J]. JAMA, 1995, 274(5):387-393. [14] Meng Q, Wang W, Liu X, et al. Escalated radiation and prophylactic extended field nodal irradiation are beneficial for FIGO ⅢB cervical cancer patients' prognosis[J]. Radiat Oncol, 2018, 13(1):223. DOI:10.1186/s13014-018-1172-1. [15] Haie C, Pejovic MH, Gerbaulet A, et al. Is prophylactic para-aortic irradiation worthwhile in the treatment of advanced cervical carcinoma? Results of a controlled clinical trial of the EORTC radiotherapy group[J]. Radiother Oncol, 1988, 11(2):101-112. DOI:10.1016/0167-8140(88)90245-9. [16] Park SG, Kim JH, 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. [17] Yap ml, 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. [18] 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. [19] Fletcher GH, Rutledge FN. Extended field technique in the management of the cancers of the uterine cervix[J]. Am J Roentgenol Radium Ther Nucl Med, 1972, 114(1):116-122. [20] Lai CH, Chang CJ, Huang HJ, et al. Role of human papillomavirus genotype in prognosis of early-stage cervical cancer undergoing primary surgery[J]. J Clin Oncol, 2007, 25(24):3628-3634. DOI:10.1200/JCO.2007.11.2995. [21] Vázquez-Vicente D, Fernández Del Bas B, García Villayzán J, et al. Laparoscopic paraaortic surgical staging in locally advanced cervical cancer:a single-center experience[J]. Clin Transl Oncol, 2018, 20(11):1455-1459. DOI:10.1007/s12094-018-1878-4. [22] Shim SH, Kim DY, Lee SJ, et al. Prediction model for para-aortic lymph node metastasis in patients with locally advanced cervical cancer[J]. Gynecol Oncol, 2017, 144(1):40-45. DOI:10.1016/j.ygyno.2016.11.011. [23] Berman ml, Keys H, Creasman W, et al. Survival and patterns of recurrence in cervical cancer metastatic to periaortic lymph nodes (a gynecologic oncology group study)[J]. Gynecol Oncol, 1984, 19(1):8-16. DOI:10.1016/0090-8258(84)90151-3. [24] De Cuypere M, Lovinfosse P, Goffin F, et al. Added value of para-aortic surgical staging compared to (18) F-FDG PET/CT on the external beam radiation field for patients with locally advanced cervical cancer:an ONCO-GF study[J]. Eur J Surg Oncol, 2020, 46(5):883-887. DOI:10.1016/j.ejso.2019.11.496. [25] Yu W, Kou C, Bai W, et al. The diagnostic performance of PET/CT scans for the detection of para-aortic metastatic lymph nodes in patients with cervical cancer:A meta-analysis[J]. PLoS One, 2019, 14(7):e0220080. DOI:10.1371/journal.pone.0220080. [26] Ramirez PT, Jhingran A, Macapinlac HA, et al. Laparoscopic extraperitoneal para-aortic lymphadenectomy in locally advanced cervical cancer:a prospective correlation of surgical findings with positron emission tomography/computed tomography findings[J]. Cancer, 2011, 117(9):1928-1934. DOI:10.1002/cncr.25739. [27] Huang EY, Wang CJ, Chen HC, et al. Multivariate analysis of para-aortic lymph node recurrence after definitive radiotherapy for stage Ⅰ b-IVA squamous cell carcinoma of uterine cervix[J]. Int J Radiat Oncol Biol Phys, 2008, 72(3):834-842. DOI:10.1016/j.ijrobp.2008.01.035. [28] Smits RM, Zusterzeel PL, Bekkers RL. Pretreatment retroperitoneal para-aortic lymph node staging in advanced cervical cancer:a review[J]. Int J Gynecol Cancer, 2014, 24(6):973-983. DOI:10.1097/IGC.0000000000000177. [29] Cheng-Yen Lai J, Lai KJ, Yi-Yung Yu E, et al. Sentinel lymphatic mapping among women with early-stage cervical cancer:A systematic review[J]. Taiwan J Obstet Gynecol, 2018, 57(5):636-643. DOI:10.1016/j.tjog.2018.08.004. [30] Meng Q, Liu X, Wang W, et al. Evaluation of the efficacy of prophylactic extended field irradiation in the concomitant chemoradiotherapy treatment of locally advanced cervical cancer, stage ⅢB in the 2018 FIGO classification[J]. Radiat Oncol, 2019, 14(1):228. DOI:10.1186/s13014-019-1431-9. [31] Lee J, Song Y, Soh EY. Prognostic significance of the number of metastatic lymph nodes to stratify the risk of recurrence[J]. World J Surg, 2014, 38(4):858-862. DOI:10.1007/s00268-013-2345-6. [32] Carneiro SR, Fagundes MA, do Rosário P, et al. Five-year survival and associated factors in women treated for cervical cancer at a reference hospital in the brazilian amazon[J]. PLoS One, 2017, 12(11):e0187579. DOI:10.1371/journal.pone.0187579. [33] Zhang G, He F, Fu C, et al. Definitive extended field intensity-modulated radiotherapy and concurrent cisplatin chemosensitization in the treatment of Ib2-ⅢB cervical cancer[J]. J Gynecol Oncol, 2014, 25(1):14-21. DOI:10.3802/jgo.2014.25.1.14. [34] Han X, Wen H, Ju X, et al. Predictive factors of para-aortic lymph nodes metastasis in cervical cancer patients:a retrospective analysis based on 723 para-aortic lymphadenectomy cases[J]. Oncotarget, 2017, 8(31):51840-51847. DOI:10.18632/oncotarget.16025. [35] 吕晓娟, 俞华, 陈鲁. 宫颈癌腹主动脉旁淋巴结转移的危险因素分析[J]. 现代实用医学, 2011, 23(8):917-918,920. DOI:10.3969/j.issn.1671-0800.2011.08.038. Lyu XJ, Yu H,Chen L. Risk factor analysis of para-aortic lymph node metastasis in cervical cancer[J]. Modern Practical Medicine, 2011,23(08):917-918,920. DOI:10.3969/j.issn.1671-0800.2011.08.038. [36] 韦羽梅, 姚德生, 李菲, 等. 宫颈癌腹主动脉旁淋巴结转移的高危因素分析[J]. 中华肿瘤防治杂志, 2013, 20(14):1110-1112. Wei YM, Yao DS,Li F,et al. Analysis of risk factors for para-aortic lymph node metastasis of cervical cancer[J]. Chin J Cancer Prev,2013,20(14):1110-1112. [37] Oh J, Seol KH, Lee HJ, et al. Prophylactic extended-field irradiation with concurrent chemotherapy for pelvic lymph node-positive cervical cancer[J]. Radiat Oncol J, 2017, 35(4):349-358. DOI:10.3857/roj.2017.00367. [38] Liang JA, Chen SW, Hung YC, et al. Low-dose, prophylactic, extended-field, intensity-modulated radiotherapy plus concurrent weekly cisplatin for patients with stage Ⅰ b2-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.0b013e31829f4dc5. [39] 刘思洋. 宫颈癌腹主动脉旁淋巴结引流区预防性调强放疗的临床研究[D]. 石家庄:河北医科大学,2018. Liu SY. Clinical study on preventive intensity modulated radiotherapy in the drainage area of abdominal para-aortic lymph node of cervical cancer[D]. Shijiazhuang:Hebei Medical University,2018.
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