title: Para-aortic workup in locally advanced cervical cancer: heterogeneity is still the rule. Results from a retrospective multicenter study.
abstract: OBJECTIVE
  We retrospectively studied the different strategies of para-aortic (PA) staging of patients with PA involvement in locally advanced cervical cancer as conducted in eight centers in France and their impact upon survival and management.
  
  
  METHODS
  All patients enrolled in this multicenter study presented with cervical cancer with PA involvement. The diagnosis of PA spread was based on imaging assessment of the PA area and/or pathological examination of harvested PA lymph nodes when staging lymphadenectomy was performed. Imaging modalities comprised positron emission tomography (PET), magnetic resonance imaging and/or computed tomography. Survival outcomes were evaluated retrospectively.
  
  
  RESULTS
  One hundred and fifteen women were retrospectively studied. Radiological staging was conducted in 101 (87.8 %) patients. PET was performed in 66 patients (57.4 %). Its FN rate was 22.7 % (15/66) and its sensitivity 77.3 %. Para-aortic lymphadenectomy was conducted in a large proportion of patients (67.8 %). Its indications were not restricted to negative radiological workup. The lymphadenectomy rate was significantly higher in patients with earlier stages (p = 0.02) and lower tumor volume (p = 0.01). Treatment consisted of chemoradiation therapy with extended-field radiotherapy in all patients, followed by intracavitary brachytherapy in 94 cases (81.7 %) and completion surgery in 69 cases (60 %). Patients without para-aortic metastasis on radiological examination were more likely to receive all treatment modalities (p = 0.04).
  
  
  CONCLUSIONS
  Despite established recommendations, our results point out the tremendous heterogeneity regarding para-aortic assessment. These differences in management are perhaps related to a recommended therapeutic strategy that does not appear to improve the poor prognosis associated with PA involvement.
authors.affiliation: Department of Gynecological Surgery, CHU Rangueil, Toulouse, France. echantalat@yahoo.fr.
authors.forename: Elodie
authors.initials: E
authors.lastname: Chantalat
authors.affiliation: Department of Gynecological Surgery, CHU Purpan, Toulouse, France.
authors.forename: Fabien
authors.initials: F
authors.lastname: Vidal
authors.affiliation: Department of Gynecological Surgery, CHU Rangueil, Toulouse, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Leguevaque
authors.affiliation: Department of Epidemiology, CHU Rangueil, Toulouse, France.
authors.forename: Benoît
authors.initials: B
authors.lastname: Lepage
authors.affiliation: Department of Gynecological Surgery, Institut Paoli-Calmettes, Marseille, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Lambaudie
authors.affiliation: Department of Gynecological Surgery, CHU Bretonneau, Tours, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hebert
authors.affiliation: Department of Gynecological Surgery, CHU Rangueil, Toulouse, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Motton
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy; D059248:Chemoradiotherapy; D005260:Female; D005602:France; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000628:therapy*
keywords: Cervical cancer; Lymphadenectomy; Para-aortic involvement; Para-aortic staging