Article, 2019

Management of Nodal Disease in Advanced Cervical Cancer

Seminars in Radiation Oncology, ISSN 1532-9461, 1053-4296, Volume 29, 2, Pages 158-165, 10.1016/j.semradonc.2018.11.002

Contributors

Jürgenliemk-Schulz, Ina Maria (Corresponding author) [1] Beriwal, Sushil [2] De Leeuw, Astrid Agatha Catharina 0000-0002-0564-2112 [1] Lindegaard, Jacob Christian 0000-0003-2426-7255 [3] Nomden, Christel Nadine 0000-0002-5553-7468 [1] Pötter, Richard C 0000-0002-0703-572X [4] Tanderup, Kari 0000-0001-7980-0681 [3] Viswanathan, Akila Ninette 0000-0002-2003-0392 [5] Erickson, Beth Ann [6]

Affiliations

  1. [1] University Medical Center Utrecht
    2. [NORA names: Netherlands; Europe, EU; OECD];
  2. [2] UPMC Hillman Cancer Center
    3. [NORA names: United States; America, North; OECD];
  3. [3] Aarhus University Hospital
    4. [NORA names: Central Denmark Region; Hospital; Denmark; Europe, EU; Nordic; OECD];
  4. [4] Medical University of Vienna
    5. [NORA names: Austria; Europe, EU; OECD];
  5. [5] Johns Hopkins Medicine
    6. [NORA names: United States; America, North; OECD];

Abstract

During the last decade the adoption of image-guided adaptive brachytherapy has dramatically improved local control in patients with locally advanced cervical cancer (LACC) treated with radiotherapy and concomitant chemotherapy; however, nodal failure remains an obstacle. Metastatic lymph nodes can be detected by surgical and imaging approaches with different sensitivities and specificities, that improve the definition of relevant targets for macroscopic and microscopic nodal disease, and that influence our understanding of dose levels of external beam radiotherapy. Systematic use of modern radiotherapy techniques including intensity modulated radiotherapy and simultaneously integrated nodal boosts in combination with daily position verification is emerging as increasingly important for obtaining nodal control in LACC. This review summarizes published and ongoing efforts for optimizing nodal disease treatment in LACC, elaborates the state of the art approach for nodal disease detection, radiotherapy planning and delivery, and discusses future investigational efforts needed for precise optimization.

Keywords

adaptive brachytherapy, adoption, advanced cervical cancer, approach, art, art approaches, beam radiotherapy, boost, brachytherapy, cancer, cervical cancer, chemotherapy, combination, concomitant chemotherapy, control, daily position verification, definition, delivery, detection, disease, disease detection, disease treatment, dose, dose levels, efforts, external beam radiotherapy, failure, image-guided adaptive brachytherapy, images, imaging approach, intensity, intensity modulated radiotherapy, investigative efforts, local control, localization, locally advanced cervical cancer, lymph nodes, management, management of nodal disease, metastatic lymph nodes, microscopic nodal disease, modern radiotherapy techniques, modulated radiotherapy, nodal control, nodal disease, nodal failure, nodes, obstacles, optimization, patients, planning, position verification, radiotherapy, radiotherapy planning, radiotherapy techniques, relevant targets, review, sensitivity, specificity, state, systematic use, target, technique, treated with radiotherapy, treatment, use, verification

Funders

  • Varian Medical Systems (United States)

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