Nodal failure after chemo-radiation and MRI guided brachytherapy in cervical cancer: Patterns of failure in the EMBRACE study cohort

Radiother Oncol. 2019 May;134:185-190. doi: 10.1016/j.radonc.2019.02.007. Epub 2019 Feb 26.


Purpose/objective(s): To investigate the patterns of nodal failure in patients enrolled in the international multicentre EMBRACE study.

Materials/methods: Nodal disease at diagnosis (N-, N+) and nodal failure were analysed per region (NF) (pelvic (parametrial, common iliac, internal/external iliac), inguinal and para-aortic (PAO)) in 1338 patients. Treatment consisted of chemo-radiation and MRI guided brachytherapy. PAO radiotherapy and/or nodal boost was left to the treating centre. At time of diagnosis 52% of patients had pathologic nodes. Frequency analyses were performed in relation to patient, primary tumour and nodal disease characteristics, and treatment related factors.

Results: Median follow up was 34 months and 83% of NF occurred within 24 months. At diagnosis 99% of the N+ patients had pathologic nodes in the pelvis and 14% in the PAO. NFpelvic and NFPAO were reported in 55% and 68% of patients with NF, respectively. Overall NF was reported in 152 patients (11%); 7 and 16% for N- and N+ patients. Of the patients with NF, 41% were located outside the elective target (39% PAO), 40% inside and 35% inside the nodal boost target. Twelve percent of N+ patients that received a nodal boost had a NF inside the nodal boost target.

Conclusion: Within the EMBRACE study cohort the overall number of patients developing nodal failure is low, significantly lower for N- compared to N+ patients. Pathological nodes at diagnosis are mainly located in the pelvis, whereas nodal failures are more often reported in the PAO region. About 40% of all nodal failures were reported outside the treatment targets.

Keywords: Cervix cancer; Lymph nodes metastases; Nodal boost; Nodal failure; Para-aortic; Pelvis.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Brachytherapy / methods*
  • Chemoradiotherapy
  • Cohort Studies
  • Female
  • Humans
  • Lymph Nodes / pathology
  • Lymphatic Metastasis
  • Magnetic Resonance Imaging / methods
  • Middle Aged
  • Positron Emission Tomography Computed Tomography / methods
  • Radiotherapy Dosage
  • Radiotherapy, Image-Guided / methods
  • Radiotherapy, Intensity-Modulated
  • Uterine Cervical Neoplasms / diagnostic imaging*
  • Uterine Cervical Neoplasms / drug therapy
  • Uterine Cervical Neoplasms / radiotherapy
  • Uterine Cervical Neoplasms / therapy*