Impact of radiation dose and standardized uptake value of (18)FDG PET on nodal control in locally advanced cervical cancer

Figures & data

Table I. Treatment schedules of external beam radiotherapy (EBRT) and brachytherapy (BT) of locally advanced cervical cancer at University Medical Center Utrecht and Aarhus University Hospital. HDR, high-dose rate; PDR, pulsed-dose rate.

	UMCU	AUH
EBRT to elective nodal region (PTV-E)	45 Gy in 25 fractions	45 Gy in 25 fractions (Patients without nodal involvement) 50 Gy in 30 fractions (Patients with nodal involvement)
PTV-E field border	Aortic bifurcation L1/L2 if nodes at CI or higher	L4/L5 L1/L2 if nodes at CI or higher
EBRT boost to pathologic nodes	Sequential 5 or 7 fractions of 2 Gy	Simultaneous integrated 60 Gy in 30 fractions
BT to high risk CTV (HR-CTV)	Option 1: PDR 2 fractions: 19.2 Gy in 32 pulses Option 2: HDR 4 fractions of 7 Gy	Option 1: PDR (node negative) 2 fractions: 17.5 Gy in 20 pulses Option 2: PDR (node positive) 2 fractions: 15 Gy in 20 pulses

Table II. Patient and tumor characteristics for node positive and node negative patients with locally advanced cervical cancer.

	N+	N−	Total
Number of patients	84 (60%)	55 (40%)	139
Age, median (range)	48 (26–79)	49 (22–82)	49 (22–82)
Histology
Squamous cell	68 (81%)	38 (70%)	106 (77%)
Adenocarcinoma	14 (17%)	14 (25%)	28 (20%)
Adeno-squamous	2 (2%)	3 (5%)	5 (3%)
FIGO-stage
IB	17 (20%)	11 (20%)	28 (20%)
IIA	2 (2%)	7 (13%)	9 (7%)
IIB	41 (49%)	30 (54%)	71 (51%)
IIIB	19 (23%)	5 (9%)	24 (17%)
IV	5 (6%)	2 (4%)	7 (5%)

Table III. Location of nodal metastases at time of diagnosis (84 patients) and at time of failure (21 patients). In some patients nodal metastases and nodal failures was diagnosed in more than one region.

Nodal region	At time of diagnosis (84 patients)	At time of failure (21 patients)
Para-aortic nodes	9 (11%)	15 (71%)
Common iliac	21 (25%)	1 (5%)
Internal/external iliac	80 (95%)	5 (24%)
Parametrial	8 (10%)	0
Inguinal	3 (4%)	1 (5%)
Pre-sacral	2 (2%)	0

Figure 1. Location of all failures (41 patients) and nodal failures (21 patients). Overlap is due to patients failing in more than one region. Local failures are here defined as persistent disease or recurrence of the primary tumor. Nodal failures consist both of failures within the electively irradiated volumes as well as non-irradiated para-aortic failures. Distant failures do not included para-aortic failures below L1.

Figure 2. Panel A shows the nodal dose and nodal volume for controlled (white) and failed nodes (black). All nodes were considered pathologic at diagnosis. Panel B shows the nodal dose and nodal SUV_max for controlled (white) and failed nodes (black).