Definitive radiotherapy with nodal boost for radiologically positive nodes in carcinoma cervix – A retrospective cohort study

ABSTRACT Background and Purpose: Definitive radiotherapy (RT) with concurrent cisplatin-based chemotherapy (CT) is the standard of care for the treatment of locally advanced carcinoma uterine cervix. Lymph node (LN) metastasis is one of the major prognostic factors. We plan to analyze the node-positive carcinoma cervix (NPCC) patients treated at our institution. Materials and Methods: All NPCC treated with Definitive RT with or without concurrent CT from January 2013 to December 2021 were included in the analysis. Patients were treated to a dose of 4500 cGy, and the gross LNs were boosted to a dose of 6000 cGy in conventional fractionation (180-200 cGy) using three-dimensional conformal radiotherapy or intensity modulated-image guided radiotherapy (3DCRT/IM-IGRT) along with high dose rate (HDR) brachytherapy. We plan to analyze overall survival (OS), disease-free survival (DFS), toxicities, and various factors that might impact the outcome of treatment. Results: 92 patients were eligible for analyses. With a median follow-up of 36 months, two patients lost to follow-up. The 3-year and 5-year OS was 86% and 77%, respectively. On log-rank analysis, the number of LNs boosted significantly impacted the OS but not with any other factors. The 3-year and 5-year DFS was 81% and 77%, respectively. There were 16 (17.2%) Grade 3 acute toxicities in 15 patients. The most common acute toxicity was gastrointestinal (6.45%). Four patients (4.3%) had developed Grade 3-4 late toxicity. Conclusions: Definitive radiotherapy with concurrent chemotherapy for NPCC with boost to the enlarged LNs results in good survival outcomes with acceptable toxicities.