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10.1245/s10434-007-9526-1
Annals of Surgical Oncology 14:3223-3231 (2007)
© 2007 Society of Surgical Oncology
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Original Article

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

Yann Delpech, MD, Christine Haie-Meder, MD, Annie Rey, MD, Yaelle Zafrani, MD, Catherine Uzan, MD, Sebastien Gouy, MD, Patricia Pautier, MD, Catherine Lhommé, MD, Pierre Duvillard, MD, Damienne Castaigne, MD and Philippe Morice, MD

Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805, Villejuif, France

Correspondence: Address correspondence and reprint requests to: Philippe Morice, MD; E-mail: morice{at}igr.fr

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.

Key Words: Cervical cancer • Completion surgery • Lymph node involvement • Para-aortic node • Survival




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M. Boughanim, S. Leboulleux, A. Rey, C. Tuan Pham, Y. Zafrani, P. Duvillard, J. Lumbroso, C. Haie-Meder, M. Schlumberger, and P. Morice
Histologic Results of Para-Aortic Lymphadenectomy in Patients Treated for Stage IB2/II Cervical Cancer With Negative [18F]Fluorodeoxyglucose Positron Emission Tomography Scans in the Para-Aortic Area
J. Clin. Oncol., May 20, 2008; 26(15): 2558 - 2561.
[Abstract] [Full Text] [PDF]


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