Prospects for para-aortic irradiation in treatment of cancer of the cervix

Abstract

The incidence of para-aortic node metastasis in cancer of the cervix ranges from 5%to 50% in clinical Stages i-iv. Extended field irradiation is being administered more frequently because of high incidence of extrapelvic disease. The cancer of the cervix material at Walter Reed General Hospital has been analyzed as to site and time of failure to determine who might have benefited from extended field irradiation. Of patients who fail, the majority will have uncontrolled pelvic disease regardless of other involvement. Diagnostic procedures including staging laparotomy are unable to predict pelvic failure or the presence of occult distant disease in lung and bone. The maximum number of patients who could benefit from pari-aortic irradiation is lessthan 3% of a total series. It is concluded that the salvage of patients with para-aortic metastasis will be small, but for those few long-term survivors, the benefit will be great.

Pretreatment Retroperitoneal Para-aortic Lymph Node Staging in Advanced Cervical Cancer: A Review

“…However, both CT and MRI are poor at detecting small volume of disease and therefore limited by low sensitivity and specificity. 11,50 Accordingly, our study shows PPVs of CT and/or MRI ranging from 0% to 66%, with a false-negative rate from 9% to 35%.…”

“…5,8Y10 Failure to detect metastases to these lymph nodes may lead to suboptimal treatment and subsequently to decrease in survival. 11 Several imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomographyYCT (PET-CT) have been used in the preoperative staging process. Although PET-CT seems the most sensitive, its limitation in diagnosing microscopic lymph node spread is specified as metastases up to 5 mm.…”

Advances in diagnosis, staging, and management of cervical and endometrial cancer, stages I and II

“…Critical analysis suggests minimal improvement in net survival. [106][107][108] Complications may be substantial, even in surviving patients.…”

Surgical approaches for advanced or recurrent cancer of the cervix

“…retrospectively studied the interval from treatment to recurrence, the incidence of failure in the pelvis and at distant sites, and concluded that only about 3% of the total number of patients seen might have benefited from extended field irradiation. 26 This finding is similar to other reports in the literature and roughly approximates the figure calculated from the data presented in this ar-…”