title: Cervical cancer with paraaortic metastases: significance of residual paraaortic disease after surgical staging.
abstract: Cervical carcinoma frequently metastasizes to the paraaortic region, necessitating extended field radiotherapy to effect a cure. As imaging modalities are unreliable in identifying all cases of paraaortic nodal metastases (PAN), surgical staging is often utilized prior to radiotherapy. This study was aimed at identifying factors predictive of survival in women with cervical carcinoma and paraaortic metastases. In particular, survival based on extent of paraaortic disease was examined. The study group consisted of 43 women (stages IB-IVB) identified between 1982 and 1993 who were treated with extended field radiation for cervical carcinoma with histologically confirmed paraaortic metastases. The estimated 5-year survival for the study population was 24% with a median survival of 18 months. Pelvic tumor size had a significant impact on survival with the median survival being 34 months if the primary lesion was < 6 cm compared to 14 months if > or = 6 cm (P = 0.01). Eight of the 26 (31%) women without residual PAN disease after surgical staging remain alive and disease free (mean follow-up, 74 months). In contrast, only 1 of the 17 (6%) women with gross residual PAN is alive 71 months after treatment (P = 0.05). However, a comparison of Kaplan-Meier survival curves did not show a statistically significant advantage to the surgical excision of grossly involved PAN (P = 0.98). Although long-term survival among women with grossly involved, unresected paraaortic metastases is uncommon, further study is necessary to elucidate the role of surgical excision of bulky aortic disease in women with cervical cancer.
authors.affiliation: Department of Obstetrics and Gynecology, University of California Irvine Medical Center, Orange 92668, USA.
authors.forename: P Y
authors.initials: PY
authors.lastname: Kim
authors.forename: B J
authors.initials: BJ
authors.lastname: Monk
authors.forename: S
authors.initials: S
authors.lastname: Chabra
authors.forename: R A
authors.initials: RA
authors.lastname: Burger
authors.forename: S A
authors.initials: SA
authors.lastname: Vasilev
authors.forename: A
authors.initials: A
authors.lastname: Manetta
authors.forename: P J
authors.initials: PJ
authors.lastname: DiSaia
authors.forename: M L
authors.initials: ML
authors.lastname: Berman
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta; D018196:Carcinoma, Adenosquamous / Q000556:secondary / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000556:secondary* / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery