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.
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.
Delpech
Yann
Y
Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805, Villejuif, France.
Haie-Meder
Christine
C
Rey
Annie
A
Zafrani
Yaelle
Y
Uzan
Catherine
C
Gouy
Sebastien
S
Pautier
Patricia
P
Lhommé
Catherine
C
Duvillard
Pierre
P
Castaigne
Damienne
D
Morice
Philippe
P
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*
D000970:Antineoplastic Agents; D002945:Cisplatin