PURPOSE: Positron emission tomography/computed tomography (PET/CT) is commonly used for nodal staging in locally advanced @entity5 ; however the false negative rate for @entity2333 are 20% to 25% in @entity530 . Unless surgically staged, pelvis-only treatment may undertreat @entity2333 . We have treated @entity1 with PET-positive nodes with extended field intensity modulated radiation therapy (IMRT) to address the para-aortic region prophylactically with concomitant boost to involved nodes. The purpose of this study was to assess regional control rates and recurrence patterns. METHODS AND MATERIALS: Sixty-one @entity1 with @entity5 (stage IBI-IVA) diagnosed from 2003 to 2012 with PET-avid pelvic nodes treated with extended field IMRT (45  Gy in 25 fractions with concomitant boost to involved nodes to a median of 55  Gy in 25 fractions) with concurrent @entity900 and brachytherapy were retrospectively analyzed. The nodal location was pelvis-only in 41 @entity1 (67%) and pelvis + para-aortic in 20 @entity1 (33%). There were a total of 179 nodes, with a median number of positive nodes of 2 (range, 1-16 nodes) per @entity1 and a median nodal size of 1.8  cm (range, 0.7-4.5  cm). Response was assessed by PET/CT at 12 to 16  weeks. RESULTS: Complete clinical and imaging response at the first follow-up visit was seen in 77% of @entity1 . At a mean follow-up time of 29  months (range, 3-116  months), 8  @entity1 experienced recurrence. The sites of persistent/recurrent disease were as follows: cervix 10 (16.3%), regional nodes 3 (4.9%), and distant 14 (23%). The rate of para-aortic failure in @entity1 with pelvic-only nodes was 2.5%. There were no significant differences in recurrence patterns by the number/location of nodes, largest node size, or maximum node standardized uptake value. The rate of late grade 3+ adverse events was 4%. CONCLUSIONS: Extended field IMRT was well tolerated and resulted in low regional recurrence in @entity5 . The dose of 55  Gy in 25 fractions was effective in eradicating disease in involved nodes, with acceptable late adverse events. Distant @entity3 is the predominant mode of failure, and the OUTBACK trial may challenge the presented paradigms.

Extended Field Intensity Modulated Radiation Therapy With Concomitant Boost for Lymph Node-Positive XXXX : Analysis of Regional Control and Recurrence Patterns in the Positron Emission Tomography/Computed Tomography Era.

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity5 :: ('MESH:D009369', 'Disease') :: ['node-positive cervical cancer', 'cervical cancer'] @entity900 :: ('MESH:D002945', 'Chemical') :: ['cisplatin'] @entity530 :: ('MESH:D010386', 'Disease') :: ['PET-positive pelvic nodal disease'] @entity3 :: ('MESH:D009362', 'Disease') :: ['metastasis'] @entity2333 :: ('MESH:D001018', 'Disease') :: ['para-aortic disease']
@entity5 :: (MESH:D009369,Disease) :: ['Cervical Cancer']
