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

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Risk factors for nodal failure after radiochemotherapy and image guided brachytherapy in locally advanced cervical cancer : An EMBRACE analysis. / Peters, Max; de Leeuw, Astrid A.C.; Nomden, Christel N.; Tanderup, Kari; Kirchheiner, Kathrin; Lindegaard, Jacob C.; Kirisits, Christian; Haie-Meder, Christine; Sturdza, Alina; Fokdal, Lars; Mahantshetty, Umesh; Hoskin, Peter; Segedin, Barbara; Bruheim, Kjersti; Rai, Bhavana; Huang, Fleur; Cooper, Rachel; van der Steen-Banasik, Elzbieta; van Limbergen, Erik; Pieters, Bradley R.; Tan, Li Tee; van Rossum, Peter S.N.; Nesvacil, Nicole; Nout, Remi; Schmid, Maximilian P.; Pötter, Richard; Jürgenliemk-Schulz, Ina M.; EMBRACE Collaborative Group.

In: Radiotherapy and Oncology, Vol. 163, 10.2021, p. 150-158.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

Harvard

Peters, M, de Leeuw, AAC, Nomden, CN, Tanderup, K, Kirchheiner, K, Lindegaard, JC, Kirisits, C, Haie-Meder, C, Sturdza, A, Fokdal, L, Mahantshetty, U, Hoskin, P, Segedin, B, Bruheim, K, Rai, B, Huang, F, Cooper, R, van der Steen-Banasik, E, van Limbergen, E, Pieters, BR, Tan, LT, van Rossum, PSN, Nesvacil, N, Nout, R, Schmid, MP, Pötter, R, Jürgenliemk-Schulz, IM & EMBRACE Collaborative Group 2021, 'Risk factors for nodal failure after radiochemotherapy and image guided brachytherapy in locally advanced cervical cancer: An EMBRACE analysis', Radiotherapy and Oncology, vol. 163, pp. 150-158. https://doi.org/10.1016/j.radonc.2021.08.020

APA

Peters, M., de Leeuw, A. A. C., Nomden, C. N., Tanderup, K., Kirchheiner, K., Lindegaard, J. C., Kirisits, C., Haie-Meder, C., Sturdza, A., Fokdal, L., Mahantshetty, U., Hoskin, P., Segedin, B., Bruheim, K., Rai, B., Huang, F., Cooper, R., van der Steen-Banasik, E., van Limbergen, E., ... EMBRACE Collaborative Group (2021). Risk factors for nodal failure after radiochemotherapy and image guided brachytherapy in locally advanced cervical cancer: An EMBRACE analysis. Radiotherapy and Oncology, 163, 150-158. https://doi.org/10.1016/j.radonc.2021.08.020

CBE

Peters M, de Leeuw AAC, Nomden CN, Tanderup K, Kirchheiner K, Lindegaard JC, Kirisits C, Haie-Meder C, Sturdza A, Fokdal L, Mahantshetty U, Hoskin P, Segedin B, Bruheim K, Rai B, Huang F, Cooper R, van der Steen-Banasik E, van Limbergen E, Pieters BR, Tan LT, van Rossum PSN, Nesvacil N, Nout R, Schmid MP, Pötter R, Jürgenliemk-Schulz IM, EMBRACE Collaborative Group. 2021. Risk factors for nodal failure after radiochemotherapy and image guided brachytherapy in locally advanced cervical cancer: An EMBRACE analysis. Radiotherapy and Oncology. 163:150-158. https://doi.org/10.1016/j.radonc.2021.08.020

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Author

Peters, Max ; de Leeuw, Astrid A.C. ; Nomden, Christel N. ; Tanderup, Kari ; Kirchheiner, Kathrin ; Lindegaard, Jacob C. ; Kirisits, Christian ; Haie-Meder, Christine ; Sturdza, Alina ; Fokdal, Lars ; Mahantshetty, Umesh ; Hoskin, Peter ; Segedin, Barbara ; Bruheim, Kjersti ; Rai, Bhavana ; Huang, Fleur ; Cooper, Rachel ; van der Steen-Banasik, Elzbieta ; van Limbergen, Erik ; Pieters, Bradley R. ; Tan, Li Tee ; van Rossum, Peter S.N. ; Nesvacil, Nicole ; Nout, Remi ; Schmid, Maximilian P. ; Pötter, Richard ; Jürgenliemk-Schulz, Ina M. ; EMBRACE Collaborative Group. / Risk factors for nodal failure after radiochemotherapy and image guided brachytherapy in locally advanced cervical cancer : An EMBRACE analysis. In: Radiotherapy and Oncology. 2021 ; Vol. 163. pp. 150-158.

Bibtex

@article{2e553156537a46fc8ff92af3e4ee4911,
title = "Risk factors for nodal failure after radiochemotherapy and image guided brachytherapy in locally advanced cervical cancer: An EMBRACE analysis",
abstract = "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. {\textquoteleft}small pelvis{\textquoteright} 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 {\textquoteleft}any CI nodes without PAO nodes{\textquoteright} 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 {\textquoteleft}any PAO nodes{\textquoteright} (with or without pelvic nodes) or {\textquoteleft}any CI nodes{\textquoteright} (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 {\textquoteleft}small pelvis{\textquoteright} and/or CI region at time of diagnosis.",
keywords = "(Para-aortic) nodal failure, EMBRACE, Risk factors",
author = "Max Peters and {de Leeuw}, {Astrid A.C.} and Nomden, {Christel N.} and Kari Tanderup and Kathrin Kirchheiner and Lindegaard, {Jacob C.} and Christian Kirisits and Christine Haie-Meder and Alina Sturdza and Lars Fokdal and Umesh Mahantshetty and Peter Hoskin and Barbara Segedin and Kjersti Bruheim and Bhavana Rai and Fleur Huang and Rachel Cooper and {van der Steen-Banasik}, Elzbieta and {van Limbergen}, Erik and Pieters, {Bradley R.} and Tan, {Li Tee} and {van Rossum}, {Peter S.N.} and Nicole Nesvacil and Remi Nout and Schmid, {Maximilian P.} and Richard P{\"o}tter and J{\"u}rgenliemk-Schulz, {Ina M.} and {EMBRACE Collaborative Group}",
note = "Publisher Copyright: {\textcopyright} 2021",
year = "2021",
month = oct,
doi = "10.1016/j.radonc.2021.08.020",
language = "English",
volume = "163",
pages = "150--158",
journal = "Radiotherapy & Oncology",
issn = "0167-8140",
publisher = "Elsevier Ireland Ltd.",

}

RIS

TY - JOUR

T1 - Risk factors for nodal failure after radiochemotherapy and image guided brachytherapy in locally advanced cervical cancer

T2 - An EMBRACE analysis

AU - Peters, Max

AU - de Leeuw, Astrid A.C.

AU - Nomden, Christel N.

AU - Tanderup, Kari

AU - Kirchheiner, Kathrin

AU - Lindegaard, Jacob C.

AU - Kirisits, Christian

AU - Haie-Meder, Christine

AU - Sturdza, Alina

AU - Fokdal, Lars

AU - Mahantshetty, Umesh

AU - Hoskin, Peter

AU - Segedin, Barbara

AU - Bruheim, Kjersti

AU - Rai, Bhavana

AU - Huang, Fleur

AU - Cooper, Rachel

AU - van der Steen-Banasik, Elzbieta

AU - van Limbergen, Erik

AU - Pieters, Bradley R.

AU - Tan, Li Tee

AU - van Rossum, Peter S.N.

AU - Nesvacil, Nicole

AU - Nout, Remi

AU - Schmid, Maximilian P.

AU - Pötter, Richard

AU - Jürgenliemk-Schulz, Ina M.

AU - EMBRACE Collaborative Group

N1 - Publisher Copyright: © 2021

PY - 2021/10

Y1 - 2021/10

N2 - 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.

AB - 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.

KW - (Para-aortic) nodal failure

KW - EMBRACE

KW - Risk factors

UR - http://www.scopus.com/inward/record.url?scp=85114733937&partnerID=8YFLogxK

U2 - 10.1016/j.radonc.2021.08.020

DO - 10.1016/j.radonc.2021.08.020

M3 - Journal article

C2 - 34480958

AN - SCOPUS:85114733937

VL - 163

SP - 150

EP - 158

JO - Radiotherapy & Oncology

JF - Radiotherapy & Oncology

SN - 0167-8140

ER -