title: Lymph node involvement in locally advanced cervical cancer patients administered preoperative chemoradiation versus chemotherapy.
abstract: BACKGROUND
  A retrospective study was planned in 127 locally advanced cervical cancer (LACC) to investigate: (1) the rate and pattern of metastatic lymph node involvement in patients administered preoperative chemoradiation (CT/RT) versus neoadjuvant chemotherapy (NACT), and (2) the profile of clinico-pathological parameters predictive of metastatic lymph node involvement in these two clinical settings. Finally, we investigated whether the pathologically assessed status of lower pelvic nodes (LPN) was able to predict the pathologically assessed status of upper pelvic nodes (UPN) and parametrium in cases administered CT/RT.
  
  
  METHODS
  Patients were selected including LACC patients who were administered concomitant CT/RT (n = 87) or NACT (n = 40), before radical surgery.
  
  
  RESULTS
  Metastatic pelvic lymph node involvement was significantly lower in cases administered CT/RT (11.5%) compared to cases administered NACT (30.0%) (P value = 0.009). In the CT/RT group, only MRI-assessed pelvic node status (both at staging and post-treatment evaluation) was associated with pathologic pelvic node status. In patients administered CT/RT, the status of LPN appeared associated with the status of UPN.
  
  
  CONCLUSIONS
  (1) Preoperative CT/RT treatment is associated with a lower rate of pelvic node disease in LACC patients compared to NACT; (2) there is no association between the preoperative extent of residual cervical disease after CT/RT and pathologically assessed pelvic node status; (3) the pathological status of LPN is predictive of the pathological status of UPN and parametrium.
authors.affiliation: Gynecologic Oncology Unit, Catholic University of Rome, L.go A. Gemelli 8, 00168, Rome, Italy. gabriella.ferrandina@libero.it
authors.forename: Gabriella
authors.initials: G
authors.lastname: Ferrandina
authors.forename: Mariagrazia
authors.initials: M
authors.lastname: Distefano
authors.forename: Manuela
authors.initials: M
authors.lastname: Ludovisi
authors.forename: Alessio
authors.initials: A
authors.lastname: Morganti
authors.forename: Daniela
authors.initials: D
authors.lastname: Smaniotto
authors.forename: Giuseppe
authors.initials: G
authors.lastname: D'Agostino
authors.forename: Francesco
authors.initials: F
authors.lastname: Fanfani
authors.forename: Giovanni
authors.initials: G
authors.lastname: Scambia
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary* / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy / Q000628:therapy*