Node positive cervical cancer: impact of pelvic irradiation and patterns of failure

Stock, Richard G.; Chen, Alex S.J.; Flíckinger, John C.; Seski, Jan C.

doi:10.1016/0360-3016(93)90631-5

Cited by 12 publications

(19 citation statements)

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“…The utility of postoperative RT for cervical cancer remains controversial (2,4,11,16,17) . The benefits of postoperative RT depend on the surgical findings: whether intrapelvic or extrapelvic microscopic residual disease that will cause recurrence exists.…”

Section: Discussionmentioning

confidence: 99%

“…Major pathologic risk factors identified included positive lymph nodes, tumor size, stromal invasion, parametrial extension, and lymph-vascular space invasion (1)(2)(3)(4)(5)(6)(7)(8)(9)(10) . Apart from these factors, clinical risk factors assessible before treatment, such as histologic type and grade, clinical stage, and clinical tumor diameter, were also considered important.…”

mentioning

confidence: 99%

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Use of small pelvic field instead of whole pelvic field in postoperative radiotherapy for node-negative, highrisk stages I and II cervical squamous cell carcinoma

Ohara

Tsunoda

Nishida

et al. 2003

International Journal of Gynecological Cancer

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We investigated whether a small pelvic (SP) field that covers primarily the pericervical regions in postoperative radiotherapy for cervical squamous cell carcinoma is adequate for a subgroup of node-negative patients. Of 84 patients with stage I–II disease treated with postoperative radiotherapy due to pathologic risk factors, 42 node-negative patients received SP-field radiotherapy, whereas remaining 42 node-positive patients were treated with a conventional whole pelvic (WP) field that also covered pelvic lymph nodes, both with 50.0–50.4 Gy/25–28 fractions. The pathologic risk factors included positive nodes, deep stromal invasion (≥2 /3 thickness), parametrial extension, and positive or close surgical margin. Recurrence was identified for 20 patients: three in the SP group and 17 in the WP group. Intrapelvic recurrence accounted for all three recurrences in the SP group and for four in the WP group; 5-year pelvic-control rate did not differ significantly between the SP (93%) and WP (90%) groups. Extrapelvic recurrence (n = 11) was identified exclusively in the WP group. Patterns of recurrence indicate that use of an SP field instead of a WP field may be adequate in postoperative radiotherapy for a subgroup of node-negative, high-risk patients.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Use of small pelvic field instead of whole pelvic field in postoperative radiotherapy for node-negative, highrisk stages I and II cervical squamous cell carcinoma

Ohara

Tsunoda

Nishida

et al. 2003

International Journal of Gynecological Cancer

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“…Thus systemic therapy should be offered for those with node-positive pT2b lesions. Many investigators have shown that survival after radical hysterectomy was impacted by lymph node status (4)(5)(6)(7)(8)(9) . Other risk factors include primary tumorrelated factors such as contaminated surgical margin, depth of invasion, and capillary lymphatic space involvement.…”

Section: Discussionmentioning

confidence: 99%

“…However, their eligibility included mainly clinical stage Ib to IIa disease, and adjuvant therapies for stage IIb disease were not widely examined in Western countries because these patients have mainly been treated by initial radical radiotherapy. Patients with pathologic T2b (pT2b) disease by TNM classification (3) consisted of those with and without pelvic lymph node metastasis, which is considered to be one of the most important prognosticators (4)(5)(6)(7)(8)(9) . Thus whether patients with pT2b lesion can be uniformly treated with concurrent chemoradiation is yet to be determined.…”

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confidence: 99%

Adjuvant pelvic irradiation in patients with pathologic T2b carcinoma of the uterine cervix

Uno,

Ito,

Itami

et al. 2002

Int J Gynecol Cancer

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Patients with cervical cancer are subject to postoperative adjuvant therapy if the histopathologic examination reveals parametrial involvement. This study evaluated the patterns of failure in patients with pathologic parametrial invasion (pT2b) treated with adjuvant pelvic irradiation. Between April 1985 and March 1997, 45 patients with pT2b cervical cancer were treated with postoperative pelvic irradiation. The median age was 52 years. Preoperative clinical stages were stage Ib in 8 patients, IIa in 4, and IIb in 33. Twenty-three patients had lymph node metastasis. The median total dose of whole pelvic radiation therapy was 50 Gy. Occurrence of pelvic failure or distant metastasis according to the nodal status was examined. None of the 22 patients without lymph node metastasis developed distant metastasis. Among the 23 node-positive patients, 6 developed distant metastasis as an initial failure site. The 5-year overall survival of the entire group was 78%. The actuarial distant metastasis-free rates at 5 years were 73% and 100% for those with and without pelvic lymph node metastasis, respectively (P= 0.016). Results support previous evidence for chemoradiation in patients with pelvic lymph node metastasis. However, it appears that the role of systemic chemotherapy for node-negative pT2b patients is yet to be established.

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“…Depending on the preoperative selection of cases, up to 50% or more of patients may be submitted to this adjuvant radiotherapy. Comparative trials (5)(6)(7)(8) are likely to demonstrate that it reduces recurrence rates. This preventative effect is due to the efficiency of radiotherapy in treating ''subclinical disease,'' ie, its effect on the invisible metastasis that develops in the pelvic cellulolymphatic tissue left in situ.…”

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confidence: 99%

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

Dargent¹,

Lamblin

Romestaing

et al. 2005

Int J Gynecol Cancer

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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.

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Node positive cervical cancer: impact of pelvic irradiation and patterns of failure

Cited by 12 publications

References 0 publications

Use of small pelvic field instead of whole pelvic field in postoperative radiotherapy for node-negative, highrisk stages I and II cervical squamous cell carcinoma

Use of small pelvic field instead of whole pelvic field in postoperative radiotherapy for node-negative, highrisk stages I and II cervical squamous cell carcinoma

Adjuvant pelvic irradiation in patients with pathologic T2b carcinoma of the uterine cervix

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

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