Clinical outcomes of external radiotherapy boost versus no boost to radiologically positive lymph nodes in FIGO stage IIIC cervical cancer.

Objective: The management of lymph node-positive cervical cancer remains controversial, with limited data on outcomes following radiotherapy. In this retrospective study, we aimed to compare the clinical outcomes in patients who had received an additional boost to radiologically positive lymph nodes versus those who did not.

Methods: A total of 231 patients with cervical cancer treated between January 2012 and December 2019 and identified as having radiologically positive lymph nodes were sorted into 2 groups: those who had received an external radiotherapy boost and those who had not. Sub-group analyses were performed based on lymph node size and number, as well as receipt of concurrent chemotherapy.

Results: For patients with International Federation of Gynecology and Obstetrics stage IIIC cervical cancer, predominantly of the squamous sub-type, with a median age of 42.5 years (range; 33-85) and a median follow-up of 11 months (range; 3-119) the median disease-free and overall survival durations were 93 months (range; 6-120) and 84 months (range; 8-120), respectively. The median overall survival was higher in the group that had received an external radiation boost compared with those who had not (107 vs 91 months; P = .01). However, no overall survival benefit from a nodal boost was observed in patients with lymph nodes >2 cm or >4 positive nodes (105 vs 99 months, P = .048; 91 vs 73 months, P = .04, respectively). Concurrent chemotherapy improved median survival by 22 months (P = .023) in the nodal boost group.

Conclusions: An external radiation boost was associated with improved overall survival in stage III cervical cancer, particularly in patients with fewer than 4 involved nodes, nodes <2 cm, and those receiving concurrent chemotherapy.