1056: Prospective Trial of Concurrent Chemoradiation With IMRT to 60 Gy for Positive Para-aortic Lymph Nodes in Carcinoma of the Cervix

Abstract

To evaluate the feasibility and toxicity of irradiation of FDG-PET positive para-aortic lymph nodes to 60 Gy in patients with carcinoma of the cervix. This is a prospective pilot treatment study of 14 patients with FDG-PET positive para-aortic lymph nodes from cervical cancer. Patients with evidence of metastatic disease or positive supraclavicular lymph nodes were ineligible. Using IMRT over 30 fractions, 50.4 Gy to the para-aortic lymph node region and 60 Gy to involved para-aortic lymph nodes was delivered. Also, patients received pelvic radiation, intracavitary brachytherapy, and weekly cisplatin for six cycles. Toxicity was evaluated and recorded weekly during therapy and with each follow-up according to the Common Toxicity Criteria (CTC) scale. All 14 patients received the prescribed 60 Gy IMRT to the positive para-aortic lymph nodes. Median follow-up was 9 months (range 1-24). Symptomatic acute grade 3-4 toxicity occurred in only 2 of 14 patients. None required a treatment break due to acute toxicity. Late toxicity was grade 4 proctitis in one. There were no grade 5 toxicities. It is feasible to deliver doses up to 60 Gy to positive para-aortic lymph nodes using IMRT without substantial toxicity.