ArticleInternational journal of gynecological cancer : official journal of the International Gynecological Cancer Society2022
Treatment of bulky lymph nodes in locally advanced cervical cancer: boosting versus debulking.
Article in International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 2 of them syntheses that pooled it.
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12 citing papers in PubMed, 2 syntheses or guidelines pooled it, 24 citations in OpenAlex.
- Survival Benefit of Surgical Staging Before Radiotherapy in Locally Advanced Cervical Cancer: A Pooled Analysis.Cancer science · 2025Pooled it
- Lymph node dissection before initial treatment for locally advanced cervical cancer: A systematic review and meta-analysis.Biomolecules & biomedicine · 2024Pooled it
- Primary chemoradiation versus radical hysterectomy with lymphadenectomy for stage IIICr cervical cancer without parametrial involvement: gynecologic oncology research investigators collaboration study (GORILLA-1002).Journal of gynecologic oncology · 2026Article
- Current Paradigm and Future Directions in the Management of Nodal Disease in Locally Advanced Cervical Cancer.Cancers · 2025Review
- Prognostic Significance of Bulky Nodal Disease in Anal Cancer Management: A Multi-institutional Study.Cancer research and treatment · 2024Article
- Therapeutic effects of surgical debulking of metastatic lymph nodes in cervical cancer IIICr: a trial protocol for a phase III, multicenter, randomized controlled study (KGOG1047/DEBULK trial).Journal of gynecologic oncology · 2024Article
- Controversies and Advances in the Personalized Surgical Treatment of Cervical Cancer.Journal of personalized medicine · 2024Review
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- Article
- An Update on the Role of MRI in Treatment Stratification of Patients with Cervical Cancer.Cancers · 2023Review
- Simultaneous Integrated Boost for Dose Escalation in Node-Positive Cervical Cancer: 5-Year Experience in a Single Institution.Cancers · 2023Article
- Efficacy of lymph node dissection on stage IIICr of cervical cancer before CCRT: study protocol for a phase III, randomized controlled clinical trial (CQGOG0103).Journal of gynecologic oncology · 2023Article
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Authors and funding
15 authors at 9 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTreatment strategies for bulky lymph nodes in patients with locally advanced cervical cancer scheduled for definitive chemoradiation include nodal boosting with radiotherapy, surgical debulking, or both. The aim of this retrospective cohort study was to compare survival and toxicity in patients receiving these treatments and to compare them with a group that received neither form of treatment.
methodsWomen diagnosed between January 2009 and January 2017 with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IB2, IIA2-IVA cervical cancer with lymph nodes ≥1.5 cm without upper limit on pretreatment imaging and treated with definitive chemoradiation were selected from the Netherlands Cancer Registry. Patients were categorized by intention-to-treat strategy: boosting, debulking, or neither treatment, with subgroup analysis for patients receiving both treatments, that is, debulking with boosting. Overall and relapse-free survival outcomes were compared by Kaplan-Meier and Cox regression analyses and toxicity by logistic regression analysis.
resultsOf 190 patients, 101 (53%) received only nodal boosting, 31 (16%) debulking alone, 29 (15%) debulking combined with boosting, and 29 (15%) received neither treatment. The 5 year overall and relapse-free survival for the treatment groups were 58%, 45% and 45% (p=0.19), and 47%, 44% and 46% (p=0.87), respectively. Multivariable Cox regression analyses demonstrated no differences in overall and relapse-free survival. Combination of debulking with boosting was associated with decreased overall and relapse-free survival compared with debulking alone (HR 2.47, 95% CI 1.22 to 5.00; and HR 2.37, 95% CI 1.14 to 4.93). Nodal boosting was independently associated with a decreased toxicity risk compared with debulking strategy (OR 0.37, 95% CI 0.16 to 0.83).
conclusionsThis study showed no survival benefit from either nodal boosting or debulking strategy in patients with suspicious bulky nodes. Nodal boosting might, however, be associated with less toxicity. Dual treatment with debulking and boosting showed a worse survival outcome because this group probably represents patients with poor prognostic factors.
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