title: Management of Para-aortic Lymph Node Disease in Patients With Cervical Cancer: What Is the Best Approach?
abstract: Cervical cancer remains a prevalent and deadly disease in low-income countries, especially among young and otherwise healthy women. Multimodality treatment has led to a significant improvement in outcomes for patients with locally advanced disease, and this is mainly because of the incorporation of platinum-based chemoradiotherapy in current treatment protocols. However, locally advanced tumors are associated with a greater risk for para-aortic lymph node (PALN) involvement, which is an important adverse prognostic factor. Most staging techniques have low accuracy for detection of disease in this area, which could lead to understaging and undertreatment. Meanwhile, patients with PALN disease are underrepresented in trials addressing the treatment of advanced cervical cancer and a few studies have been directed at this population. The aim of this review is to analyze the current data regarding staging and treatment of cervical cancer with PALN disease to determine which strategy is best when managing these patients.
authors.affiliation: Department of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Marcelo Vailati
authors.initials: MV
authors.lastname: Negrão
authors.forename: Julianne Maria da Silva
authors.initials: JM
authors.lastname: Lima
authors.forename: Samantha Cabral Severino
authors.initials: SC
authors.lastname: Silva
authors.forename: Maria Del Pilar Estevez
authors.initials: MD
authors.lastname: Diz
authors.forename: Vanessa
authors.initials: V
authors.lastname: da Costa Miranda
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology* / Q000528:radiation effects / Q000601:surgery; D008207:Lymphatic Metastasis; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy*