Risk factors for nodal failure after radiochemotherapy and image guided brachytherapy in locally advanced cervical cancer: An EMBRACE analysis

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  • Max Peters, Utrecht University
  • ,
  • Astrid A.C. de Leeuw, Utrecht University
  • ,
  • Christel N. Nomden, Utrecht University
  • ,
  • Kari Tanderup
  • Kathrin Kirchheiner, Medical University of Vienna
  • ,
  • Jacob C. Lindegaard
  • Christian Kirisits, Medical University of Vienna
  • ,
  • Christine Haie-Meder, Institut Gustave Roussy
  • ,
  • Alina Sturdza, Medical University of Vienna
  • ,
  • Lars Fokdal
  • Umesh Mahantshetty, Tata Memorial Hospital
  • ,
  • Peter Hoskin, East and North Hertfordshire NHS Trust
  • ,
  • Barbara Segedin, Institute of Oncology Ljubljana
  • ,
  • Kjersti Bruheim, University of Oslo
  • ,
  • Bhavana Rai, Postgraduate Institute of Medical Education and Research
  • ,
  • Fleur Huang, Cross Cancer Institute
  • ,
  • Rachel Cooper, Leeds Teaching Hospitals NHS Trust
  • ,
  • Elzbieta van der Steen-Banasik, Radiotherapiegroep Arnhem
  • ,
  • Erik van Limbergen, KU Leuven
  • ,
  • Bradley R. Pieters, University of Amsterdam
  • ,
  • Li Tee Tan, Cambridge University Hospitals NHS Foundation Trust
  • ,
  • Peter S.N. van Rossum, Utrecht University
  • ,
  • Nicole Nesvacil, Medical University of Vienna
  • ,
  • Remi Nout, Leiden University
  • ,
  • Maximilian P. Schmid, Medical University of Vienna
  • ,
  • Richard Pötter, Medical University of Vienna
  • ,
  • Ina M. Jürgenliemk-Schulz, Utrecht University
  • ,
  • EMBRACE Collaborative Group

Objective: To assess risk factors for nodal failure (NF) after definitive (chemo)radiotherapy and image-guided brachytherapy for locally advanced cervical cancer (LACC) for patients treated in the EMBRACE I study. Materials and methods: Data for pelvic NF and para-aortic (PAO) NF (NFPAO) were analysed. After multiple imputation, univariable and multivariable Cox-regression was performed for clinical and treatment-related variables. For patients with affected pelvic nodes but no PAO nodes at diagnosis, additional analyses were performed for two subgroups: 1. ‘small pelvis’ nodes in internal and external iliac, obturator, parametrial, presacral and/or common iliac (CI) region and 2. any CI nodes (subgroup of 1). Results: 1338 patients with 152 NF and 104 NFPAO events were analysed with a median follow-up of 34.2 months (IQR 16.4–52.7). For the entire group, larger tumour width, nodal risk groups (in particular any CI nodes without PAO nodes), local failure, and lower Hb-nadir increased the risk of NF. Elective PAO-irradiation was independently associated with a decreased risk of NFPAO (HR 0.53, 95%-CI 0.28–1.00, p = 0.05). For subgroup 1, having ‘any CI nodes without PAO nodes’ and local failure significantly increased NF risk. Additionally, elective PAO-irradiation was associated with less risk of NFPAO (HR 0.38, 95%-CI 0.17–0.86, p = 0.02). For subgroup 2 only local failure was associated with higher risk of NF. Conclusion: In this patient cohort, nodal disease and tumour width at diagnosis, as well as local failure, are risk factors for NF after definitive treatment. Having either ‘any PAO nodes’ (with or without pelvic nodes) or ‘any CI nodes’ (without PAO nodes) are stronger risk factors than involvement of nodes in the small pelvis alone. Elective PAO-irradiation was associated with significantly less NFPAO, particularly in patients with nodal disease in the ‘small pelvis’ and/or CI region at time of diagnosis.

Original languageEnglish
JournalRadiotherapy and Oncology
Volume163
Pages (from-to)150-158
Number of pages9
ISSN0167-8140
DOIs
Publication statusPublished - Oct 2021

Bibliographical note

Publisher Copyright:
© 2021

    Research areas

  • (Para-aortic) nodal failure, EMBRACE, Risk factors

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