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Abstract
Introduction The dose prescription for nodes is heterogenous and choice of optimal dose is unclear. This study was designed to report nodal response in patients receiving simultaneous integrated boost (SIB) for stage IIIC cervical cancer.
Methods Patients who received chemoradiation and nodal dose escalation through SIB followed by brachytherapy were included. As per RECIST 1.1, baseline lymph node was categorized as pathological if short axis diameter (SAD) was ≥10 mm and measurable if SAD ≥15 mm or as a non-target if SAD ≥10 mm, but <15 mm. On follow-up, if SAD was < 10 mm, the node was considered non-pathologic. Nodal Control and Disease-Free Survival (DFS) was determined. Log-rank test was used for evaluation of impact of nodal RECIST baseline nodal category, nodal volume and dose on nodal control and disease-free survival (DFS).
Results Sixty-six patients with 153 nodes were included. Patient characteristics and treatment details are depicted in table 1. Median SIB dose was 55Gy (45- 56.5Gy). Number of nodes receiving dose < 50Gy were 7 (4.6%), 51–55Gy: 36 (23.5%) and >55Gy:110 (71.9%). At response assessment 92.2% nodes (n=141) had complete response, 6.5% (n=10) had partial response and 1.3% (n=2) had progressive disease. The median follow up was 33 months (9–66 months). Patients receiving > 55Gy had better 5-year nodal control (84.6% vs 58.7% p=0.02, figure 1). Reduced 5-yr DFS (76% vs 44%, p=0.15) was also observed based on RECIST definition though it was not statistically significant.
Conclusion/Implications Dose escalation to nodes leads to significantly better nodal control. Further dose escalation may need investigation.
