Table 4.

Literature review of reported gross lymphadenopathy control in gynecologic malignancies

	Study	IMRT	Boost type	Node + patients	Para-aortic ± pelvic nodes (%)	Dose to GND,	Elective dose	Nodal control ratea) (%)	Follow-up (mo)	Toxicity grade ≥3 (%)				Comment
						Dose per fraction (Gy)				Acute		Late
										GI	GU	GI	GU
Primary cervicalb)	Ariga et al. [17]	No	Seq	57	0	56.0 (50.0–60.0),	40	91.2	66	-	-	4	-
						2.0
	Bacorro et al. [4]	0.16	SIB or Seq	108	16.7	55.3 (44–78.9)c),	45	81.5	34	-	-	-	-	75 with boost
						- (1.8–2.18)
	Choi et al. [15]	No	Seq	11	0	50.4 (50.4–59.4),	45	81.8	19	9.1	0	9.1	9.1
						1.8
		No	None	35	0	45 (-),	45	79.3	44	0	0	8.6	2.9
						1.8
	Dang et al. [25]	Yes	SIB	74	46	62.5 (-),	45–50	100	36	8.1	0	5.5	0
						2.5
	Grigsby et al. [1]	No	Seq	33	100	45 (33.9–45.0),	-	100	-	-	-	-	-
						1.8
		No	Seq	132	0	-(66.8–74.1),	-	96.2	27	-	-	-	-
						1.8
	Hata et al. [20]	No	Seq	62	0	53.1 (45.0–61.2),	50.4 (45–50.4)	98.2	33	0	0	8.1	3.2	32 with boost
						1.8 (1.8–2)
	Macchia et al. [47]	Yes (EF)	SIB	-	-	45, 2.25 (n=13)	40–45	-	-	21.1g)	0	-	-
						50, 2.5 (n=6)
	Ramlov et al. [26]	-	SIB+Seq	84	11	62.4 (53.0–69.0)c),	45–50	92	-	-	-	-	-	75 with boost
						- (1.67–2)
	Vargo et al. [24]	Yes (EF)	SIB	61	33	55 (54.0–59.4),	45	93.9	29	0	0	4	0
						2.2 (2.2-2.4)
	Wakatsuki et al. [13]	No	None	32	-	50.6 (25.2–51)d),e)	50.6 (25.2–51)d),e)	88.5d)	56	0	0	0	0
		No	Seq	46	-	55.4 (45.0–60.6),	50.6 (25.2–51)d),e)	88.5d)	55	0	0	0	0
						- (1.8–2)
	Wujanto et al. [14]	0.167	None	31	6.5	50.63 (42.5–68.2)c),	45–50.4	-	26	0	3.2d),h)	0	3.2d)
						1.8
		0.167	Seq	36	19.4	58.4 (49.6–69)c),	45–50.4	-	25	0	5.6d)	0	5.6d)
						1.8
	Yoon et al. [18]	Yes	Seq	48	0	63.0 (59.4–68.4), 1.8	45–54f)	–	36	-	-	-	-
	Current studyi)	Yes	SIB	42	76.2	63 (56.3–63), 2.25	50.4 (45–50.4)	100	12	7.2d)	0d)	12.0d)	0d)
	Yoshizawa et al. [16]	No	None	32	0	50 (45–50), 2(1.8–2)	50 (45–50)	87.5	28	19	-	-	-
Endometrial or mixed gynecologic malignancies	Ho et al. [3]	Yes	SIB and/or Seq	38	66	64.7 (59–73), - (1.8–2.25)	45–50	61	30	-	-	7.9	5.3	100; all nodally recurrent;
														n=16 SIB, 7 Seq, 15 both
	Townamchai et al. [28]	Yes	Seq	22	59	63 (55–65),	45 (37.8–45)	86	38	4.5	0	0	0	100;
						1.8								54.5% recurrent;
														22.7% definitive
	Rajasooriyar et al. [32]	No	Seq	126	18	- (50.4–54), 1.8	45	-	53	-	-	-	-	100; all adjuvant
	Poorvu [49]	Yes (EF)	Seq	46	100	54 (41.4–65),	45	-	17	6.5	-	6.5	-	76.1;
						2								37% recurrent;
														32 received boost
	Current studyd)	Yes	SIB	83	73.5	63 (56.3–63),	50.4 (45–50.4)	97.6	13	7.2	0	12	0	33.7;
						2.25								32% recurrent;
														14% definitive
	Boyle et al. [33]	Yes (EF)	SIB±Seq	39	28.2	61.15 (55–65)	45	-	18	2.5	0	0	0	43.6;
						- (2–2.2)								20.5% recurrent;
														55 Gy w/ SIB ± Seq to 65 Gy
Recurrent para-aortic (endometrial or cervical)	Shirvani et al. [40]	Yes	SIB and/or Seq	27	100	61.7 (54–66),	45–50	70	25	-	-	18.5	-	52
						-
	Niibe et al. [34]	No	None	84	100	50.8 (25–60),	50.8 (25–60)	-	20	-	-	0	0	89.3
						- (1.7–2)
	Kim et al. [38]	No	Seq	12	100	60 (50.4–60),	45.6–50.4	66	19	0	0	-	-	100
						1.2 bid
	Singh et al. [39]	No	None	14	100	45 (25.2–50.4),	45 (25.2–50.4)	-	19.7	7.1	-	-	7.1	42.9;
						1.2 bid–1.8 qd								salvage RT to 11 of 14
	Chou et al. [35]	No	None	26	100	45 (-),	45	-	-	-	-	-	-	100;
						1.8								RT to 15 of 26
	Current studyi)	Yes	SIB	15	100	63 (56.3–63),	50.4 (45–50.4)	100	14	7.2d)	0d)	12.0d)	0d)	53.3
						2.25

IMRT, intensity-modulated radiation therapy; GND, gross nodal disease; GI, gastrointestinal; GU, genitourinary; Seq, sequential; SIB, simultaneous integrated boost; EF, extended field (all patients); bid, twice daily; qd, once daily; RT, radiotherapy.

^a)Partial response or complete response without progression at last follow-up,

^b)excluding Macchia, all published manuscripts with >30 node positive patients,

^c)denoting equivalent total doses in 2 Gy fractions (EQD2),

^d)all node positive patients in study,

^e)whole pelvic field and central shielding fields,

^f)includes boost doses to the parametrium,

^g)15.4% lowest dose and 33% highest dose,

^h)only reported proctitis and cystitis,

ⁱ⁾cohort subset.