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Optimal prophylactic para-aortic radiotherapy in locally advanced cervical cancer: anatomy-based versus margin-based delineation
  1. Jie Lee1,2,
  2. Jhen-Bin Lin3,
  3. Chih-Long Chang2,4,
  4. Ya-Ting Jan5,
  5. Yu-Jen Chen1 and
  6. Meng-Hao Wu1
  1. 1 Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan
  2. 2 Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
  3. 3 Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan
  4. 4 Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
  5. 5 Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan
  1. Correspondence to Dr Jie Lee, Department of Radiation Oncology, Mackay Memorial Hospital, Taipei, Taiwan; sinus125125{at}gmail.com

Abstract

Objective Precise delineation of the para-aortic nodal region is critical for the optimal therapeutic ratio of prophylactic para-aortic radiotherapy. We aimed to evaluate the para-aortic control and patient-reported gastrointestinal toxicity in patients with locally advanced cervical cancer who received anatomy-based or margin-based prophylactic para-aortic radiotherapy.

Methods We analyzed 160 patients with locally advanced cervical cancer who received prophylactic extended-field radiotherapy between January 2014 and November 2019 at two tertiary centers. Para-aortic nodal regions were delineated based on the anatomic principle-based atlas or marginal expansion from the aorta and inferior vena cava. The Patient-Reported Outcome version of the Common Terminology Criteria for Adverse Events was used to assess acute gastrointestinal toxicity, and a score of ≥3 was defined as severe gastrointestinal toxicity.

Results Seventy-six (47.5%) and 84 (52.5%) patients received anatomy-based and margin-based prophylactic para-aortic radiotherapy, respectively. The median follow-up was 40.1 months (IQR 25.5–58.9). Para-aortic nodal failures occurred in one (1.3%) patient in the anatomy-based para-aortic radiotherapy group and in one (1.2%) patient in the margin-based para-aortic radiotherapy group (p=1.00). There was no in-field or marginal para-aortic nodal failure. The 3-year para-aortic recurrence-free survival for anatomy-based and margin-based para-aortic radiotherapy was 98.6% and 98.8%, respectively (p=0.94). Patients who received anatomy-based para-aortic radiotherapy reported less severe acute gastrointestinal toxicity than those who received margin-based para-aortic radiotherapy (13.2% vs 29.8%, p=0.01). A comparison of gastrointestinal toxicities showed that patients who received anatomy-based para-aortic radiotherapy reported significantly less severe gastrointestinal toxicity than those who received margin-based para-aortic radiotherapy in terms of frequency of diarrhea (7.9% vs 20.2%, p=0.03), severity of abdominal pain (3.9% vs 14.3%, p=0.03), and interference of abdominal pain (2.6% vs 11.9%, p=0.03).

Conclusion Anatomy-based prophylactic para-aortic radiotherapy achieved excellent para-aortic control and a lower incidence of severe patient-reported gastrointestinal toxicity. These findings suggest that anatomy-based delineation optimizes clinical outcomes of prophylactic para-aortic radiotherapy in locally advanced cervical cancer.

  • cervical cancer
  • radiotherapy, intensity-modulated

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Contributors Conceptualization: JL. Data curation: JL, J-BL, and C-LC. Formal analysis: Y-TJ and M-HW. Funding acquisition: JL. Supervision: JL, C-LC and Y-JC. Writing - original draft: JL and J-BL. Writing - review and editing: All authors. Guarantor: JL.

  • Funding This work was supported by the Ministry of Science and Technology Taiwan (grant number: Contract No. MOST 110-2314-B-195-033).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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