Research progress of para-aortic prophylactic extended-field irradiation in locally advanced cervical cancer
WANG Yuanjing1 WU Yumei2
1.Radiation Therapy Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University Beijing Maternal and Child Health Care Hospital, Beijing 100006, China;
2.Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University Beijing Maternal and Child Health Care Hospital, Beijing 100006, China
Abstract：Cervical cancer is the most common malignancy of the female reproductive system. Para-aortic prophylactic extended-field irradiation is recommended for locally advanced cervical cancer patients with positive common iliac or para-aortic lymph nodes. For patients with negative common iliac or para-aortic lymph nodes, the standard treatment is still pelvic radiotherapy with concurrent cisplatin-based chemotherapy. However, para-aortic lymph node metastasis is one of the common causes of treatment failure in locally advanced cervical cancer patients after chemo-radiotherapy. Currently, it is controversial whether to perform prophylactic extended-field irradiation for patients with high-risk factors of para-aortic lymph node metastasis. This article reviews the value of PET/CT in evaluating para-aortic lymph node metastasis of cervical cancer, the effectiveness and indications of prophylactic extended-field irradiation, hoping to provide an important reference for individualized precision radiotherapy for cervical cancer.
[1] Mayadev J，Zamarin D，Deng W，et al. Anti-PD-L1 （atezolizumab） as an immune primer and concurrently with extended-field chemoradiotherapy for node-positive locally advanced cervical cancer [J]. Int J Gynecol Cancer，2020，30（5）：701-704.
[2] Musunuru HB，Pifer PM，Mohindra P，et al. Advances in management of locally advanced cervical cancer [J]. Indian J Med Res，2021，154（5）：248-261.
[3] Loverix L，Salihi RR，Van Nieuwenhuysen E，et al. Para- aortic lymph node surgical staging in locally-advanced cervical cancer：comparison between robotic versus conventional laparoscopy [J]. Int J Gynecol Cancer，2020，30（4）：466- 472.
[4] Gennigens C，De Cuypere M，Hermesse J，et al. Optimal treatment in locally advanced cervical cancer [J]. Expert Rev Anticancer Ther，2021，21（6）：657-671.
[5] Kunogi H，Yamaguchi N，Terao Y，et al. Dosimetric predictors of nephrotoxicity in patients receiving extended-field radiation therapy for gynecologic cancer [J]. Radiat Oncol，2021，16（1）：25.
[6] Yilmaz B，Dag S，Ergul N，et al. The efficacy of pretreatment and after treatment 18F-FDG PET/CT metabolic parameters in patients with locally advanced squamous cell cervical cancer [J]. Nucl Med Commun，2019，40（3）：219-227.
[7] Cegla P，Urbanski B，Burchardt E，et al. Influence of 18F- FDG-PET/CT on staging of cervical cancer [J]. Nuklearmedizin，2019，58（1）：17-22.
[8] Martinez A，Angeles MA，Querleu D，et al. How should we stage and tailor treatment strategy in locally advanced cervical cancer? Imaging versus para-aortic surgical staging [J]. Int J Gynecol Cancer，2020，30（9）：1434-1443.
[9] D'Cunha P，Albuquerque K，Xi Y，et al. Correlating quantitative para-aortic lymph node computed tomography parameters with fluorodeoxyglucose positron emission tomography for cervical cancer staging：possible solution for resource constrained countries [J]. J Comput Assist Tomogr，2022，46（4）：551-559.
[10] Liu B，Gao S，Li S，et al. A comprehensive comparison of CT，MRI，positron emission tomography or positron emission tomography/CT，and diffusion weighted imaging-MRI for detecting the lymph nodes metastases in patients with cervical cancer：a meta-analysis based on 67 studies [J]. Gynecol Obstet Invest，2017，82（3）：209-222.
[11] Yoshida K，Kondo E，Matsumoto T，et al. Laparoscopic retro- peritoneal para-aortic lymph node biopsy in advanced cervical cancer with pelvic lymph node metastases：a single-center prospective study [J]. J Obstet Gynaecol Res，2021，47（11）：3951-3957.
[12] Gouy S，Seebacher V，Chargari C，et al. False negative rate at 18F-FDG PET/CT in para-aortic lymphnode involvement in patients with locally advanced cervical cancer：impact of PET technology [J]. BMC Cancer，2021，21（1）：135.
[13] Ramirez PT，Jhingran A，Macapinlac HA，et al. Laparoscopic extraperitoneal para-aortic lymphadenectomy in locally advanced cervical cancer：a prospective correlation of surgical findings with positron emission tomography/computed tomography findings [J]. Cancer，2011，117（9）：1928- 1934.
[14] Carre A，Sellier J，Kamga M，et al. Para-aortic lymph node staging in grade ⅠB2 and above cervical cancers：comparison of 18FDG PET-CT with para-aortic lymphadenectomy，using data from the C?觝te d'Or gynaecological cancer registry from 2003 to 2016 [J]. Gynecol Obstet Fertil Senol，2021，49（9）：677-683.
[15] Shim SH，Kim DY，Lee SJ，et al. Prediction model for para- aortic lymph node metastasis in patients with locally advanced cervical cancer [J]. Gynecol Oncol，2017，144（1）：40-45.
[16] Han X，Wen H，Ju X，et al. Predictive factors of para-aortic lymph nodes metastasis in cervical cancer patients：a retrospective analysis based on 723 para-aortic lymphadenectomy cases [J]. Oncotarget，2017，8（31）：51840-51847.
[17] Wang W，Liu X，Meng Q，et al. Nomogram for predicting para-aortic lymph node metastases in patients with cervical cancer [J]. Arch Gynecol Obstet，2018，298（2）：381-388.
[18] Lee J，Lin JB，Chang CL，et al. Impact of para-aortic recurrence risk-guided intensity-modulated radiotherapy in locally advanced cervical cancer with positive pelvic lymph nodes [J]. Gynecol Oncol，2018，148（2）：291-298.
[19] Wang W，Zhou Y，Wang D，et al. Prophylactic extended- field irradiation in patients with cervical cancer：a literature review [J]. Front Oncol，2020，10：579410.
[20] Small WJ，Bosch WR，Harkenrider MM，et al. NRG oncology/RTOG consensus guidelines for delineation of clinical target volume for intensity modulated pelvic radiation therapy in postoperative treatment of endometrial and cervical cancer：an update [J]. Int J Radiat Oncol Biol Phys，2021， 109（2）：413-424.
[21] Yang B，Liu X，Hu K，et al. Reduction of dose to duodenum with a refined delineation method of Para-aortic region in patients with locally advanced cervical cancer receiving prophylactic extended-field radiotherapy [J]. Radiat Oncol，2019，14（1）：196.
[22] Wang D，Wang W，Liu X，et al. A modified delineation method of para-aortic nodal clinical target volume in patients with locally advanced cervical cancer [J]. Cancer Med，2022，11（1）：28-39.
[23] Luo W，Li Y，Ke G，et al. Extended field or pelvic intensity-modulated radiotherapy with concurrent cisplatin chemotherapy for the treatment of post-surgery multiple pelvic lymph node metastases in cervical cancer patients：a randomized, multi-center phase Ⅱ clinical trial [J]. Transl Cancer Res，2021，10（1）：361-371.
[24] Ballari N，Rai B，Bahl A，et al. Prospective observational study evaluating acute and delayed treatment related toxicities of prophylactic extended field volumetric modulated arc therapy with concurrent cisplatin in cervical cancer patients with pelvic lymph node metastasis [J]. Tech Innov Patient Support Radiat Oncol，2021，17：48-56.
[25] Kim JH，Kim JY，Yoon MS，et al. Prophylactic irradiation of para-aortic lymph nodes for patients with locally advanced cervical cancers with and without high CA9 expression （KROG 07-01）：a randomized，open-label，multicenter，phase 2 trial [J]. Radiother Oncol，2016，120（3）：383-389.
[26] Miriyala R，Rai B，Ballari NR，et al. Prospective study to quantify expansion volumes around the involved pelvic lymph nodes to plan simultaneous integrated boost in patients with cervical cancer undergoing pelvic intensity modulated radiation therapy [J]. Pract Radiat Oncol，2019，9（4）：e394-e399.
[27] Biplab M，Tapas M，Debarshi L，et al. Intensity modulated radiotherapy in carcinoma cervix with metastatic para-aortic nodes：an institutional experience from a Regional Cancer Centre of Eastern India [J]. Rep Pract Oncol Radiother，2021，26（3）：400-407.
[28] K Jensen NB，P?觟tter R，Spampinato S，et al. Dose-volume effects and risk factors for late diarrhea in cervix cancer patients after radiochemotherapy with image guided adaptive brachytherapy in the EMBRACE Ⅰ Study [J]. Int J Radiat Oncol Biol Phys，2021，109（3）：688-700.
[29] Horn LC，Brambs CE，Opitz S，et al. The 2019 FIGO classification for cervical carcinoma-what's new? [J]. Pathologe，2019，40（6）：629-635.
[30] Wakatsuki M，Kato S，Ohno T，et al. Multi-institutional observational study of prophylactic extended-field concurrent chemoradiation therapy using weekly cisplatin for patients with pelvic node-positive cervical cancer in East and Southeast Asia [J]. Int J Radiat Oncol Biol Phys，2019，105（1）：183-189.
[31] Onal C，Yuce Sari S，Akkus Yildirim B，et al. Is there any benefit of paraaortic field irradiation in pelvic lymph node positive endometrial cancer patients? A propensity match analysis [J]. J Obstet Gynaecol，2020，40（7）：1012-1019.
[32] Wang W，Liu X，Meng Q，et al. Prophylactic extended-field irradiation for patients with cervical cancer treated with concurrent chemoradiotherapy：a propensity-score matching analysis [J]. Int J Gynecol Cancer，2018，28（8）：1584- 1591.
[33] Park SG，Kim JH，Oh YK，et al. Is prophylactic irradiation to para-aortic lymph nodes in locally advanced cervical cancer necessary? [J]. Cancer Res Treat，2014，46（4）：374- 382.
[34] Sanders JC，Muller DA，Dutta SW，et al. Para-aortic nodal radiation in the definitive management of node-positive cervical cancer [J]. Front Oncol，2021，11：664714.
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