BACKGROUND: Despite local control now exceeding 90% with image-guided adaptive brachytherapy (IGABT), regional and distant @entity3 continue to curb survival in locally advanced cervical @entity5 . As regional lymph nodes often represent first site of metastatic spread, improved nodal control could improve survival. The aim of this study was to examine optimal volume and dose of external beam radiotherapy (EBRT) to maximize regional control including dose contribution from IGABT. MATERIAL AND METHODS: In total 139 @entity1 from the EMBRACE study were analyzed. Individual nodal dose was determined by dose-maps from EBRT and IGABT. All PET/CT scans were re-evaluated and nodal maximal standard uptake value (SUVmax) was determined. Nodal failures were registered to planning scans and related to boosted nodes and treated volume. Relation between SUVmax and nodal control as well as the pattern of regional nodal failure were analyzed. RESULTS: Eighty-four @entity1 were node positive. Nine @entity1 had all metastatic nodes surgically removed. Seventy-five @entity1 had 209 nodes boosted with EBRT. Median nodal boost dose was 62 Gy EQD2 (53-69 Gy EQD2). Median SUVmax was 6 (2-22). No @entity1 had persistent @entity66 , but six @entity1 recurred in a boosted node. SUVmax was significantly higher in nodes that recurred (p = 0.02). However, there was no correlation to nodal dose or volume. Twenty-one @entity1 had a nodal failure including para-aortic nodal (PAN) @entity3 above the irradiated volume. Nine @entity1 had a PAN-only failure. @entity1 receiving  <= 4 cycles of weekly @entity900 had higher risk of nodal failure (p < 0.01). CONCLUSION: Current @entity138 practice provides a high level of control in both boosted nodes and the elective irradiated regional target. However, a high nodal SUVmax is a negative prognostic predictor for nodal control. Attention should be raised to administration of a complete schedule of concurrent chemotherapy as well as treatment of para-aortic nodes.

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

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients'] @entity66 :: ('MESH:D004194', 'Disease') :: ['nodal disease'] @entity138 :: ('MESH:C563738', 'Disease') :: ['RT'] @entity5 :: ('MESH:D009369', 'Disease') :: ['cancer'] @entity900 :: ('MESH:D002945', 'Chemical') :: ['cisplatin'] @entity3 :: ('MESH:D009362', 'Disease') :: ['metastases']
@entity5 :: (MESH:D009369,Disease) :: ['cancer']
