Department of Radiotherapy and Oncology and Regional Cancer Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Department of Radiotherapy and Oncology and Regional Cancer Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Jpn J Clin Oncol. 2014 Oct;44(10):941-7. doi: 10.1093/jjco/hyu107. Epub 2014 Aug 7.
To assess the patterns of recurrence in cervical cancer patients treated with pelvic nodal clinical target volume at L4-L5 junction instead of aortic bifurcation.
Records of patients with locally advanced cervical cancer treated with chemo-radiation were reviewed. Patients treated with standard pelvic fields (superior border of the field at L4/L5 junction), without any radiological evidence of regional lymphadenopathy (<10 mm) were included in the study. The level of aortic bifurcation was retrospectively documented on computed tomography. Patterns of recurrences were correlated to the aortic bifurcation and the superior border of the radiation fields (L4/L5).
Aortic bifurcation was above the radiation fields (above L4/5) in 82 of 116 (70.7%) patients. Of the nine patients that recurred above the radiation field, 5 (55%) were above L4/5 failures, i.e. between aortic bifurcation and L4/5, and 4 (45%) had para-aortic failures. On retrospective analysis, 16 patients were found to have subcentimeter lymph nodes and higher nodal failures (7/16) were observed in patients with subcentimeter regional lymph nodes at diagnosis.
Superior border of nodal clinical target volume should ideally include the aortic bifurcation instead of L4-L5 inter space in patients with locally advanced cervical cancer. Radiotherapy fields need to be defined cautiously in patients with subcentimeter pelvic lymph nodes.
评估宫颈癌患者采用 L4-L5 交界处盆部淋巴结临床靶区而非主动脉分叉处进行治疗后的复发模式。
回顾性分析接受放化疗的局部晚期宫颈癌患者的病历。纳入研究的患者采用标准盆部野（野的上界在 L4/L5 交界处）治疗，且无区域淋巴结病的影像学证据（<10mm）。在 CT 上回顾性记录主动脉分叉的位置。将复发模式与主动脉分叉和放射野的上界（L4/L5）相关联。
在 116 例患者中，82 例（70.7%）的主动脉分叉位于放射野（L4/5 上方）之上。在放射野上方复发的 9 例患者中，5 例（55%）为 L4/5 上方失败，即位于主动脉分叉和 L4/5 之间，4 例（45%）为主动脉旁失败。回顾性分析发现，16 例患者存在亚厘米淋巴结，且在诊断时存在亚厘米区域淋巴结的患者中观察到更高的淋巴结失败率（7/16）。
对于局部晚期宫颈癌患者，淋巴结临床靶区的上界理想情况下应包括主动脉分叉，而非 L4-L5 间隙。对于存在亚厘米盆腔淋巴结的患者，需要谨慎定义放射野。
