Abstract

BackgroundTo map anatomic patterns of para-aortic lymph node (PALN) recurrence in cervical cancer patients and validate currently available guidelines on PA clinical target volumes (CTV).MethodsCervical cancer patients who developed PALN recurrence were included. The PALNs were classified as left-lateral para-aortic (LPA), aorto-caval (AC), and right para-caval (RPC). Four PA CTVs were contoured for each patient to validate PALN coverage. CTVRTOG was contoured based on the Radiation Therapy Oncology Group guideline. CTVK was contoured as proposed by Keenan et al. CTVM was contoured by expanding symmetrical margins around the aorta and inferior vena cava of 7 mm up to the T12–L1 interspace. CTVnew was created by modifying CTVRTOG to obtain better coverage.ResultsWe identified 92 PALNs in 35 cervical cancer patients. 46.8% of the PALNs were at LPA, 38.0% were at AC, and 15.2% were at RPC areas. CTVRTOG, CTVK, and CTVM covered 87.0%, 88.0%, and 62.0% of all PALNs, respectively. PALN recurrence above the left renal vein was associated with PALN involvement at diagnosis (p = 0.043). Extending upper border to the superior mesenteric artery allowed the CTVnew to cover 96.7% of all PALNs and all nodes in 91.4% of patients.ConclusionCTVRTOG and CTVK encompassed most PALN recurrences. For high-risk patients, such as those having PALN involvement at diagnosis, extending the superior border of CTV from the left renal vein to superior mesenteric artery could be considered.

Highlights

  • To map anatomic patterns of para-aortic lymph node (PALN) recurrence in cervical cancer patients and validate currently available guidelines on PA clinical target volumes (CTV)

  • positron emission tomography/ computed tomography (PET/CT) scans of patients at the time of PALN recurrence were imported to the treatment planning system for mapping and validating

  • Patients and treatment characteristics Out of 476 cervical cancer patients who were treated with curative intent, 35 patients with 92 PALN recurrences met the eligibility criteria of the current study

Read more

Summary

Introduction

To map anatomic patterns of para-aortic lymph node (PALN) recurrence in cervical cancer patients and validate currently available guidelines on PA clinical target volumes (CTV). External beam radiotherapy generally includes the pelvis with or without the para-aortic region. The NRG/Radiation Therapy Oncology Group (RTOG) updated consensus guidelines for delineation of CTV for intensity-modulated pelvic radiation therapy in postoperative treatment of endometrial and cervical cancer including the specific PA CTV guideline [15]. Validations of these currently available guidelines through detailed PA recurrence patterns have been sparse to date

Methods
Results
Conclusion
Full Text
Published version (Free)

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call