title: Impact of boost irradiation on pelvic lymph node control in patients with cervical cancer.
abstract: Radiation therapy (RT) for metastatic pelvic lymph nodes (PLNs) is not well established in cervical cancer. In this study the correlation between size of lymph nodes and control doses of RT was analyzed. Between January 2002 and December 2007, 245 patients with squamous cell carcinoma of the cervix treated with a combination of external beam irradiation with or without boost irradiation and high-dose rate brachytherapy were investigated. Size of lymph node was measured by computed tomography before RT and just after 50 Gy RT. Of the 245 patients, 78 had PLN metastases, and a total of 129 had enlarged PLNs diagnosed as metastases; 22 patients had PLN failure. The PLN control rate at 5 years was 79.5% for positive cases and 95.8% for negative cases. In cases with positive PLNs, 12 of 129 nodes (9.3%) developed recurrences. There was significant correlation between PLN control rate and size of PLN after 50 Gy (<10 mm: 96.7%, ≥ 10 mm: 75.7 % (P<0.001)). In addition, the recurrence in these poor-response nodes was significantly correlated with dose of RT. Nine of 16 nodes receiving ≤ 58 Gy had recurrence, but none of 21 nodes receiving > 58 Gy had recurrence (P = 0.0003). These results suggested that the response of lymph nodes after RT was a more significant predictive factor for recurrence than size of lymph node before RT, and poor-response lymph nodes might require boost irradiation at a total dose of > 58 Gy.
authors.affiliation: Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Wakatsuki
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Ohno
authors.forename: Shingo
authors.initials: S
authors.lastname: Kato
authors.forename: Ken
authors.initials: K
authors.lastname: Ando
authors.forename: Shin-Ei
authors.initials: SE
authors.lastname: Noda
authors.forename: Hiroki
authors.initials: H
authors.lastname: Kiyohara
authors.forename: Kei
authors.initials: K
authors.lastname: Shibuya
authors.forename: Kumiko
authors.initials: K
authors.lastname: Karasawa
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kamada
authors.forename: Takashi
authors.initials: T
authors.lastname: Nakano
mesh_terms: D000328:Adult; D000368:Aged; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008198:Lymph Nodes / Q000528:radiation effects*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D010388:Pelvis; D011878:Radiotherapy / Q000401:mortality*; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000401:mortality* / Q000532:radiotherapy*
keywords: boost irradiation; lymph node metastasis; pelvic lymph node; radiation therapy; uterine cervical cancer
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