title: Nonoperative assessment of nodal status for locally advanced cervical squamous cell carcinoma treated by radiotherapy with regard to patterns of treatment failure.
abstract: OBJECTIVE
  Lymph node metastasis is a major prognostic factor in the treatment of cervical cancer, but its nonsurgical assessment is not necessarily accurate, particularly in small nodes. We evaluated whether node-negative status could be accurately assessed using a low cutoff measure.
  
  
  METHODS
  The subjects were 84 patients with Stage IIB-IVA cervical squamous cell carcinoma treated by definitive radiotherapy. Nodal status was assessed by CT as negative (<5 mm), possibly positive (5-10 mm), or probably positive (>10 mm). Cause-specific survival and the disease-free rate, including the pelvic recurrence-free and distant metastasis-free rates, were estimated.
  
  
  RESULTS
  The cause-specific survival, disease-free rate, and pelvic recurrence-free rate at 5 years were significantly higher for the 32 patients with node-negative disease (83.5%, 86.1%, and 86.1%) and the 17 patients with possibly node-positive disease (59.2%, 93.8%, and 93.8%) than for the 35 patients with probably node-positive disease (32.6%, 22.0%, and 46.8%), respectively. No significant difference was found between negative and possibly node-positive status. In contrast, the distant metastasis-free rate differed significantly among node-negative (96.4%), possibly node-positive (59.3%), and probably node-positive (35.1%) status.
  
  
  CONCLUSIONS
  Node-negative status assessed using a strict cutoff measure may be useful as a strong predictor of cervical cancer being confined to the pelvis.
authors.affiliation: Department of Radiation Oncology, Tsukuba University Hospital, University of Tsukuba, Tsukuba City, Japan. ki-ohara@md.tsukuba.ac.jp
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Ohara
authors.forename: Yumiko Oishi
authors.initials: YO
authors.lastname: Tanaka
authors.forename: Hajime
authors.initials: H
authors.lastname: Tsunoda
authors.forename: Shinji
authors.initials: S
authors.lastname: Sugahara
authors.forename: Takayuki
authors.initials: T
authors.lastname: Hashimoto
authors.forename: Kenji
authors.initials: K
authors.lastname: Kagei
authors.forename: Koichi
authors.initials: K
authors.lastname: Tokuuye
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Akine
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yoshikawa
authors.forename: Yuji
authors.initials: Y
authors.lastname: Itai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D010388:Pelvis; D015996:Survival Rate; D017211:Treatment Failure; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*