Extended-field radiation therapy in early-stage cervical carcinoma: Survival and complications

Clinical efficacy of applying four-field portals to paraaortic irradiation in the treatment of cervical carcinoma

“…This is, therefore, an important issue for the selection of patients who are appropriate for PAI treatment. Some investigators stress the accuracy of exploratory lymphadnectomy or percutaneous biopsy [1,2,8,9,12,[15][16][17][18][19], though these procedures may increase radiation morbidity and sometimes mortality [18,19]. In addition, postoperative radiotherapy to PAI cannot achieve sufficient therapeutic improvement [15][16][17]19].…”

“…To accurately assess the incidence of paraaortic lymph node metastasis in cervical carcinoma, diagnostic surgical examinations were performed [4,5] in which the incidence proved to be 7% in Stage IB, 5.2%-18% in Stage IIB, 19%-46.4% in Stage III, and 40%-50% in Stage IV disease. The stages increase in incidence, thus many investigators thought application of PAI to be meaningful as a prophylactic [6][7][8][9][10][11], in therapeutic (or definitive) use [12][13][14][15][16][17][18][19], and as salvage therapy for recurrence [20]. However, clinical application has been limited by the adverse effects, especially to the gastrointestinal system [2,10,12,[14][15][16][17]19,20].…”

“…However, clinical application has been limited by the adverse effects, especially to the gastrointestinal system [2,10,12,[14][15][16][17]19,20]. Exter-nal beam radiation therapy (EBRT) in PAI was often delivered by antero-posterior opposed parallel fields [2,[6][7][8][9][12][13][14][15][18][19][20][21] so that critical organs such as the stomach and small intestine would be fully included in the radiation field. Also, many clinicians applied en bloc fields [3,7,[10][11][12][13][14]18] so that large integral volumes would be treated simultaneously.…”

Cervical Cancer (Cervix Uteri)

“…Some studies, after verifying lymph node metastases, delivered radiation to this area. Some authors assert that the value of such irradiation is uncertain, while others claim that, despite histologically verified metastases in the para-aortic nodes, radiotherapy provided cure in 30% to 50% of cases (40)(41)(42)(43)(44).…”

“…A judgment expressed by Gilbert Fletcher (45) on the current findings represents the views held by many: "a dose of [40][41][42][43][44][45] Gy to the para-aortic nodes given electively can be expected to control 70% to 80% of subclinical disease, and therefore can be curative. "…”