Prophylactic irradiation of para-aortic lymph nodes in carcinoma of the uterine cervix. A prospective randomized study.
OBJECTIVE
For assessment of the advantages and side effects of para-aortic lymph nodes irradiation under the evaluation by computer tomography, a prospective randomized study was started in 1986. The results for survival, local control and late complications are presented in the following.


METHODS
From November 1986 to October 1990, 93 patients with cervical carcinoma were randomly allocated for treatment with either pelvic irradiation (pelvic group) or pelvic plus para-aortic lymph nodes irradiation (para-aortic group). Thirty-six patients underwent external irradiation and intracavitary therapy (RT arm) and 57 patients, extended radical hysterectomy and external irradiation (OP-RT arm). Para-aortic lymph nodes irradiation delivered 45 Gy in 1.8 Gy per day for 5 days per week through anterior-posterior fields.


RESULTS
The 3-year cause specific survival rates were para-aortic group: 57% and pelvic group: 89% in RT arm group, and para-aortic group: 70% and pelvic group: 86% in OP-RT arm group. Differences for the 2 groups in each treatment arm were not significant. In pelvic failure, para-aortic lymph nodes metastases and distant metastases showed no statistically significant differences for the 2 groups in each treatment arm. In the para-aortic group, complications were more frequent than in the pelvic group (13/45 vs. 2/48, p < 0.025). As an enteric complication ileus was found in 7% (3/45) of the para-aortic group while 2% (1/48) in the pelvic group. Compression fractures of the lumber vertebral body were apparent in 9% (4/45) and 0%, respectively.


CONCLUSIONS
Routine para-aortic lymph nodes irradiation delivered through anterior-posterior fields for high risk patients with cervical carcinoma is of limited value occurring to the high incidence of late complications and this treatment fails to improve no survival rates.
Chatani
M
M
Department of Radiation Therapy, Center of Adult Diseases, Osaka, Japan.
Matayoshi
Y
Y
Masaki
N
N
Narumi
Y
Y
Teshima
T
T
Inoue
T
T
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D000328:Adult; D000368:Aged; D001011:Aorta; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015182:Lymphatic Irradiation / Q000009:adverse effects / Q000379:methods; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D017211:Treatment Failure; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*