title: Para-aortic involvement and interest of para-aortic lymphadenectomy after chemoradiation therapy in patients with stage IB2 and II cervical carcinoma radiologically confined to the pelvic cavity.
abstract: BACKGROUND
  Pelvic radiation therapy with concomitant chemotherapy (PCRT) is the standard treatment of stage IB2/II cervical carcinoma. The impact of concomitant chemotherapy on positive para-aortic nodes (PA+), however, remains unknown. The aim of this study was twofold: to evaluate the rate of histological PA+ after PCRT and to determine the survival of patients with PA+.
  
  
  METHODS
  Patients fulfilling the following inclusion criteria were studied: (1) stage IB2/II cervical carcinoma, (2) histological subtype: squamous cell, adenocarcinoma or an adenosquamous tumor, (3) exclusion of patients with radiological PA+ (CT scan/MRI), (4) pelvic external radiation therapy of 45 Gy with concomitant chemotherapy (cisplatin 40 mg/m2/week) + utero-vaginal brachytherapy, and (5) completion surgery after the end of PCRT including at least a para-aortic lymphadenectomy.
  
  
  RESULTS
  Seventy-three patients (16 stage IB2, 57 stage II) treated between 1998 and 2004 fulfilled all the inclusion criteria. PA+ after PCRT were observed in 13 patients (18%) with a median of five (range, 2-22) positive nodes. Overall and disease-free survival at 24 months in patients with PA+ was 40% and 17%. Only two patients with PA+ are currently alive and in remission.
  
  
  CONCLUSIONS
  The rate of PA+ remains high after PCRT in patients treated for stage IB2/II cervical carcinoma. Furthermore, the survival rate of patients with PA+ is very low. These important results suggest that detection of PA + at the time of completion surgery (after PCRT) is not beneficial for improving survival.
authors: Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805, Villejuif, France.
authors: Yann
authors: Y
authors: Delpech
authors: Christine
authors: C
authors: Haie-Meder
authors: Annie
authors: A
authors: Rey
authors: Yaelle
authors: Y
authors: Zafrani
authors: Catherine
authors: C
authors: Uzan
authors: Sebastien
authors: S
authors: Gouy
authors: Patricia
authors: P
authors: Pautier
authors: Catherine
authors: C
authors: Lhommé
authors: Pierre
authors: P
authors: Duvillard
authors: Damienne
authors: D
authors: Castaigne
authors: Philippe
authors: P
authors: Morice
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D018196:Carcinoma, Adenosquamous / Q000473:pathology / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy; D002945:Cisplatin / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000401:mortality / Q000601:surgery*; D010220:Para-Aortic Bodies / Q000187:drug effects / Q000473:pathology* / Q000528:radiation effects; D010386:Pelvic Neoplasms / Q000473:pathology / Q000628:therapy*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin