Assessment of pretreatment laparotomy in patients with cervical carcinoma prior to radiotherapy.
One hundred fifty-five patients with cervical cancer not amenable to radical surgery underwent selective, paraaortic lymphadenectomy and exploratory laparotomy prior to the initiation of radiotherapy. Fifty-one patients underwent transperitoneal lymphadenectomy; the remainder had the procedure performed using the extraperitoneal approach. Twenty-six patients (17%) were found to have metastatic disease to the paraaortic lymph nodes. The incidence of paraaortic metastases increased with advancing clinical stage. Twenty-four of the 26 patients were treated with extended-field radiotherapy which did not exceed 5100 cGy to the paraaortic region. Twenty-three percent of the patients with positive paraaortic nodes had documented intraperitoneal tumor. Two- and five-year actuarial survival rates for patients with paraaortic metastases were 35 and 27%, respectively. Approximately 4.6% of patients undergoing a selective paraaortic lymphadenectomy derived therapeutic benefit from the information supplied by the procedure. Using a Cox model, tumor histology, status of the paraaortic lymph nodes, tumor size, and presence of intraperitoneal disease were statistically significant prognostic factors in patient survival. Tumor size and presence of intraperitoneal disease were major predictors of patient survival.
Podczaski
E S
ES
Department of Obstetrics and Gynecology, M.S. Hershey Medical Center, Pennsylvania State University, Hershey 17033.
Palombo
C
C
Manetta
A
A
Andrews
C
C
Larson
J
J
DeGeest
K
K
Mortel
R
R
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007813:Laparotomy; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*