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Regional Control and Chemoradiotherapy Dose Response for Clinically Involved Lymph Nodes in Patients with Locally Advanced Endometrial Cancers Who are Not Candidates for Upfront Surgical Staging Extrafascial Hysterectomy

Iheagwara, U.K. ; Vargo, J.A. ; Boisen, M.M. ; Taylor, S.E. ; Berger, J.L. ; Comerci, J.T. ; Orr, B.C. ; Sukumvanich, P. ; Olawaiye, A.B. ; Kelley, J.L. ; Edwards, R.P. ; Courtney-Brooks, M.B. ; Beriwal, S.

Clinical oncology (Royal College of Radiologists (Great Britain)), 2021-03, Vol.33 (3), p.e110-e117 [Periódico revisado por pares]

England: Elsevier Ltd

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  • Título:
    Regional Control and Chemoradiotherapy Dose Response for Clinically Involved Lymph Nodes in Patients with Locally Advanced Endometrial Cancers Who are Not Candidates for Upfront Surgical Staging Extrafascial Hysterectomy
  • Autor: Iheagwara, U.K. ; Vargo, J.A. ; Boisen, M.M. ; Taylor, S.E. ; Berger, J.L. ; Comerci, J.T. ; Orr, B.C. ; Sukumvanich, P. ; Olawaiye, A.B. ; Kelley, J.L. ; Edwards, R.P. ; Courtney-Brooks, M.B. ; Beriwal, S.
  • Assuntos: Dose response ; locally advanced endometrial cancer ; lymph node ; nodal boost ; pre-operative chemoradiotherapy
  • É parte de: Clinical oncology (Royal College of Radiologists (Great Britain)), 2021-03, Vol.33 (3), p.e110-e117
  • Notas: ObjectType-Article-1
    SourceType-Scholarly Journals-1
    ObjectType-Feature-2
  • Descrição: There are limited data in endometrial cancer for nodal control and appropriate treatment volume for non-surgically resected nodes treated with chemoradiotherapy (CRT) for patients who are not candidates for upfront extrafascial hysterectomy. Patients (n = 105) with clinical stage ≥ II endometrial cancer who were not candidates for upfront extrafascial hysterectomy treated with preoperative CRT were retrospectively reviewed. CRT included pelvic nodes to the common iliac for node-negative disease and para-aortic nodes to the renal vessel for any node-positive disease. Involved nodes most commonly received a boost of 55 Gy in 25 fractions ± additional 4–6 Gy sequential boost for nodes >2 cm. Of the included 95 patients, 55 patients were node positive, with a total of 300 positive nodes. At a median follow-up of 25 months (interquartile range 9–46), the 3-year regional control was 91%. The 3-year involved nodal control rate was 96%. Involved nodal control was significantly higher in type I histology, nodes <2 cm and by radiation dose (75% for <55 Gy, 98% for 55 Gy in 25 fractions and 89% for >55 Gy, P = 0.03). The 3-year para-aortic failure rate for node negative patients treated with pelvis-only CRT was significantly higher with positron emission tomography/computed tomography (PET/CT) versus computed tomography (CT)-based staging (0% versus 20%). This is the largest study examining regional control rates of involved lymph nodes with CRT for patients who were not candidates for upfront extrafascial hysterectomy. Nodal failure was low following CRT and dose ≥55 Gy in 25 fractions seems to be adequate for involved nodes. •Chemoradiotherapy controls 96% of unresected lymph nodes.•Dose response of ≥55 Gy in 25 fractions is sufficient for control of ≤2 cm involved nodes.•PET/CT directed radiotherapy volumes result in 91% regional control.•Pelvic-only radiation fields are sufficient in PET/CT-staged node-negative patients.
  • Editor: England: Elsevier Ltd
  • Idioma: Inglês
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  • Realização: ABCD-USP USP   Logos de Redes Sociais: Freepik

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