Effect of radiotherapy on pelvic lymph node metastasis in cervical cancer stages IB2–IVA: a retrospective analysis of two comparative series

Abstract

Efficiency of radiotherapy in controlling lymph node metastasis is a controversial issue. A continuous series of 87 patients affected by cervical cancer stages IB2–IVA and treated using pelvic radiotherapy is presented. A retrospective comparison is made between two populations. In the two populations, a staging lymphadenectomy was carried out before the onset of the therapeutic program. In the first population (53 patients), the pelvic nodes only were dissected and in the second one (34 patients), the pelvic lymph nodes were left in place and the paraaortic nodes only were dissected. In both series, a completion surgery was performed after finalization of the radiotherapy. It was carried out at open abdomen in both series. It included a systematic pelvic dissection for the patients whose pelvic nodes had been intentionally left in place at the time of the initial staging lymphadenectomy. Both series were identical as far as classic risk factors were concerned (FIGO stage, maximal tumor diameter, lymphovascular space involvement). The radiotherapy administered to the pelvis was the same in both populations. The number of patients with pelvic lymph node metastasis was 21 (39.6%) in the first population versus 6 (17.6%) in the second one (P = 0.03). The percentage of positive lymph nodes among the retrieved lymph nodes was 18.94 in the first population versus 2.8 in the second one (P = 0.0001). Pelvic radiotherapy is likely to control most of the pelvic lymph node metastasis, but not all of them. Practical deductions and further developments are discussed.

The Study Drug Pathomorphism And Immunohistochemical Parameters Of Tumor In Endoarterial Of Regional Long-Term Chemotherapy In Treatment Of Cervical Cancer

“…Another controversy is the question of the effectiveness of radiotherapy in the presence of metastases in the pelvic lymph nodes. D. Dargent et. al.…”

Brachytherapy versus radical hysterectomy after external beam chemoradiation: a non-randomized matched comparison in IB2-IIB cervical cancer patients

“…These results along with the existing data in literature are very suggestive that brachytherapy may be dispensable in early stage cervical cancer patients as long a radical hysterectomy with pelvic lymphadenectomy is performed. An additional potential advantage of surgical treatment is the evidence that after definitive radiation between 11 and 20% of patients are left with positive pelvic lymph nodes that remain untreated if not are removed by surgery [ 15 , 33 , 34 ]. Yet this triple modality seems promissory regarding local control and survival, surgical complications, specifically lymphocysts, fistula and hydronephrosis are more frequent to that reported in patients undergoing either upfront hysterectomy[ 35 , 36 ] or after neoadjuvant chemotherapy[ 37 ].…”