Node-positive patients with carcinoma of uterine cervix undergoing concurrent chemoradiation with or without integrated boost to positive pelvic nodes: A prospective single institutional comparative study

OBJECTIVE: Lymph nodal metastasis is a poor prognostic factor in cervical carcinoma and strongly correlates with tumor control and survival outcomes. Evaluation of the impact of nodal boost radiation on clinical outcome and toxicity profile in node-positive carcinoma of uterine cervix patients undergoing chemoradiation was the primary objective of this study. MATERIALS AND METHODS: In this study, 97 patients with node-positive carcinoma of the uterine cervix were enrolled. An alternative allocation method was used for patient allocation. In the boost arm, patients received pelvic nodal boost radiation of 55 Gy along with 50 Gy to the whole pelvis using integrated boost technique and in the nonboost arm, patients received 50 Gy radiation to the pelvis. Weekly platinum-based concurrent chemotherapy and High dose rate Brachytherapy of 7 Gy × 3 fractions were planned in each arm. 46 patients in the boost arm and 44 patients in the nonboost arm completed the treatment protocol. Tumor control, acute toxicity, failure pattern, and progression-free survival (PFS) were evaluated. RESULTS: Baseline patients and tumor characteristics were similar in both arms. The median PFS was 22 months versus 19 months. Complete nodal response was better in the boost arm (80.0% vs. 52.6%, P = 0.070). The incidence of acute toxicities did not differ significantly with nodal boost. Incidence of pelvic and para-aortic nodal recurrence and distant metastasis was 0% versus 20.4% ( P = 0.030), 19.5% vs. 36.3% ( P = 0.243), and 4.3% versus 20.4% ( P = 0.134), respectively. CONCLUSION: Chemoradiation with nodal boost for patients with node-positive carcinoma of the uterine cervix is well tolerated and beneficial.