Patterns of Failure in Node Positive Cervical Cancer Patients Treated with Radical Radiotherapy

Background: Chemoradiation plays an important role in cervical cancer treatment but dose to organs at risk (OAR) is the limitation while escalating dose to target. With conformal techniques dose escalation is made possible without increase in toxicities. Though node positive cervical cancers have poorer prognosis delivering higher dose to the involved nodes have shown benefit. We aim to determine the patterns of failure in node positive cervical cancer patients treated with chemoradiation and to determine the grade III and IV toxicities associated with it.Methods and Materials: In this retrospective study node positive cervical cancer patients treated with conformal radiotherapy were analysed. 45 Gy -50.4 Gy was given to the pelvis and 55 Gy to positive nodes with sequential or simultaneous integrated boost (SIB) in 25 -28 fractions with weekly cisplatin 40mg/m2 followed by brachy therapy. Extended fields were used to treat patients with positive para aortic lymph nodes. Treatment toxicities were recorded as per CTCAE version 4.3. Results: Of the 62 patients 87.1% had squamous cell carcinoma and majority were in stage II (38.7%). At a median follow up of 33 months two (3.2%) patients had local recurrence, eight (12.9 %) had distant failure and one (1.6%) had loco regional recurrence. Lung was the most common site of metastasis followed by the supraclavicular region. The 3 year overall and disease free survival were 91.4 % and 77.2 % respectively. Stage of the disease (p=0.001) and residue at the end of therapy (p-0.010) showed significant association with DFS but not with OS. 21 (33%) had Grade III –IV toxicities, nine (13%) having acute toxicities and 12 (19.4%) had late toxicities. Conclusion: Though node positive cervical cancers have poor prognosis our study showed that aggressive management improves the outcome without increase in toxicities.