Clinical outcome of extended‑field irradiation vs. pelvic irradiation using intensity‑modulated radiotherapy for cervical cancer

Ouyang,Yi; Wang,Yanhong; Chen,Kai; Cao,Xinping; Zeng,Yiming

doi:10.3892/ol.2017.7077

Clinical outcome of extended‑field irradiation vs. pelvic irradiation using intensity‑modulated radiotherapy for cervical cancer

Authors:
- Yi Ouyang
- Yanhong Wang
- Kai Chen
- Xinping Cao
- Yiming Zeng
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Affiliations: Department of Radiotherapy, Sun Yat‑Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, P.R. China, Department of Radiotherapy, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, P.R. China, Respiratory Department, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, P.R. China
Published online on: September 27, 2017 https://doi.org/10.3892/ol.2017.7077
Pages: 7069-7076
Copyright: © Ouyang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The aim of the present study was to evaluate the distinctions in survival and toxicity between patients with cervical cancer with common iliac node or para‑aortic node involvement, who were treated with extended‑field intensity‑modulated radiotherapy (EF‑IMRT) and patients with or without lower involved pelvic nodes, who were treated with pelvic IMRT. A total of 55 patients treated with EF‑IMRT and 52 patients treated with pelvic IMRT at the Sun Yat‑Sen University Cancer Center (Guangzhou, China) were retrospectively analyzed. Patients treated with EF‑IMRT had the highest level of lymph node involvement to the para‑aortic or common iliac nodes, while patients treated with pelvic IMRT had no para‑aortic or common iliac nodes involved (P<0.001). The median follow‑up time was 29.5 months. The 3‑year overall survival (OS) rates of EF‑IMRT and pelvic IMRT were 79.4 and 82.3% (P=0.45), respectively, and the 3‑year disease‑free survival (DFS) rates of EF‑IMRT and pelvic IMRT were 61.0 and 73.7% (P=0.55), respectively. Cox's regression analysis revealed that EF irradiation was a protective prognostic factor for OS and DFS. A total of 16 patients in the EF‑IMRT group and 13 patients in the pelvic IMRT group experienced treatment failure (P=0.67), with the patterns of failure being the same for the two groups (P=0.88). The cumulative incidence of grade 3 and 4 acute toxicities in the EF‑IMRT group was 34.5%, in comparison with 19.2% in the pelvic group (P=0.048). The results of the present study suggest that patients with cervical cancer with grossly involved common iliac or para‑aortic nodes should be electively subjected to EF irradiation to improve the survival and alter patterns of recurrence. Notably, EF irradiation delivered via IMRT exhibits an increased toxicity incidence, however, this remains within an acceptable range.

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