title: Evaluation of patients after extraperitoneal lymph node dissection and subsequent radiotherapy for cervical cancer.
abstract: OBJECTIVE
  The presence of nodal metastases is the most important prognostic factor in cervical cancer. To adjust our therapy based on the true extent of the patient's disease, we performed an extraperitoneal lymph node dissection (EPLND) in all patients with cervical cancer prior to radiotherapy (RT) or radical hysterectomy.
  
  
  METHODS
  Thirty-three patients with carcinoma of the cervix underwent EPLND. The value of this procedure as a diagnostic tool for monitoring the extension of the disease was determined. Additionally, EPLND/RT-associated treatment complications were monitored.
  
  
  RESULTS
  The combined treatment approach of EPLND with RT or chemotherapy/RT was without major complications. Nineteen patients showed a temperature elevation, but only one patient had a fever of greater than 39.0 degrees C. Fourteen (48.3%) of 29 patients experienced some degree of proctitis or diarrhea and 3 (10.3%) experienced cystitis during the course of RT. No grade 3 or 4 acute or late genitourinary or gastrointestinal toxicities were noted. EPLND changed the clinical management for 6 patients from a radical hysterectomy to RT and for 7 patients from standard-field RT to extended-field RT. Without EPLND these 7 patients would have received RT with standard pelvic fields that would not have treated involved lymph node areas at high risk for subsequent failure.
  
  
  CONCLUSIONS
  Thirteen (44.8%) of 29 patients received a different treatment than would otherwise have been administered with standard treatment planning. Therefore, we suggest that EPLND should be performed in all patients with cervical cancer prior to radical surgery or RT.
authors.affiliation: Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas 77030, USA. ahasenb@frk1.ukl.uni-freiburg.de
authors.forename: Annette
authors.initials: A
authors.lastname: Hasenburg
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Salama
authors.forename: T John
authors.initials: TJ
authors.lastname: Van
authors.forename: Chad
authors.initials: C
authors.lastname: Amosson
authors.forename: J Kam
authors.initials: JK
authors.lastname: Chiu
authors.forename: Dirk G
authors.initials: DG
authors.lastname: Kieback
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision / Q000009:adverse effects* / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009367:Neoplasm Staging; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery*