Advertisement

Pretreatment surgical staging in cervical carcinoma: Therapeutic efficacy of pelvic lymph node resection

  • Gordon O. Downey
    Correspondence
    Reprint requests: Gordon O. Downey, MD, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Box 435, Madigan Army Medical Center, Tacoma, WA 98431-5435.
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Minesota Hospital and Clinics, Minneapolis, Minnesota
    Search for articles by this author
  • Roger A. Podsh
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Minesota Hospital and Clinics, Minneapolis, Minnesota

    Department of Therapeutic Radiology, University of Minesota Hospital and Clinics, Minneapolis, Minnesota
    Search for articles by this author
  • Leon L. Adcock
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Minesota Hospital and Clinics, Minneapolis, Minnesota
    Search for articles by this author
  • Konald A. Prem
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Minesota Hospital and Clinics, Minneapolis, Minnesota
    Search for articles by this author
  • Leo B. Twiggs
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Minesota Hospital and Clinics, Minneapolis, Minnesota

    Department of Therapeutic Radiology, University of Minesota Hospital and Clinics, Minneapolis, Minnesota
    Search for articles by this author
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Pretreatment surgical staging in cervical carcinoma has been studied extensively to define a group for extended field radiation or adjuvant chemotherapy. A theoretical, but as yet unproved, benefit from this surgery is the resection of large, presumably radioresistant, pelvic nodal metastases before radiation therapy. One hundred fifty-six patients were divided by pelvic nodal status after surgical staging with excision of pelvic lymph nodes: group A, negative (n = 81); group B, microscopic metastases only (n = 18); group C, macroscopic nodal metastases resected (n = 48); and group D, unresectable nodal metastases (n = 9). The 5-year recurrence-free survival in group C (51%) approached that of group B (57%) and was significantly better than that of group D (0%). The groups are compared by International Federation of Gynecology and Obstetrics stage, grade, histology, and incidence of paraaortic metastases. Patterns of recurrence imply improved pelvic control in patients undergoing resection of pelvic nodal metastases. Surgical removal of pelvic nodal metastases before radiation therapy is recommended. (Am J Obstet Gynecol 1989;160:1055-61.)

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Potish RA
        • Twiggs LB
        • Okagaki T
        • Prem KA
        • Adcock LL
        Therapeutic implications of the natural history of advanced cervical cancer as defined by pretreatment surgical staging.
        Cancer. 1985; 56: 956-960
        • Hamberger AD
        • Fletcher GH
        Is surgical evaluation of the para-aortic nodes prior to irradiation of benefit in carcinoma of the cervix?.
        Int J Radiat Oncol Biol Phys. 1982; 8: 151-153
        • LaPolla JP
        • Schlaerth JB
        • Gaddis O
        • Morrow CP
        The influence of surgical staging on the evaluation and treatment of patients with cervical carcinoma.
        Gynecol Oncol. 1986; 24: 194-206
        • Piver MS
        Extended field irradiation in the treatment of patients with cervical carcinoma involving biopsy proven para-aortic nodes.
        Int J Radiat Oncol Biol Phys. 1984; 10: 1993-1994
        • Potish RA
        • Twiggs LB
        • Adcock LL
        • Savage JE
        • Prem KA
        • Levitt SH
        Effect of cis-platinum on tolerance to radiation therapy in advanced cervical cancer.
        Am J Clin Oncol. 1986; 9: 387-391
        • Wharton JT
        • Jones III, HW
        • Day Jr, TG
        • Rutledge FN
        • Fletcher GH
        Preirradiation celiotomy and extended field irradiation for invasive carcinoma of the cervix.
        Obstet Gynecol. 1977; 49: 333-338
        • Tewfik HH
        • Buchsbaum HJ
        • Latourette HB
        • Lifshitz SG
        • Tewfik FA
        Para-aortic lymph node irradiaton in carcinoma of the cervix after exploratory laparotomy and biopsy-proven positive aortic nodes.
        Int J Radiat Oncol Biol Phys. 1982; 8: 13-18
        • Nori D
        • Valentine E
        • Hilaris BS
        The role of paraaortic irradiation in the treatment of cancer of the cervix.
        Int J Radiat Oncol Biol Phys. 1985; 11: 1469-1473
        • Inoue T
        • Chihara T
        • Morita K
        The prognostic significance of the size of the largest nodes in metastatic carcinoma of the uterine cervix.
        Gynecol Oncol. 1984; 19: 187-193
        • Withers HR
        • Peters LJ
        Basic principles of radiotherapy: biologic aspects of radiation therapy..
        in: Fletcher GH Textbook of radiotherapy.3rd ed. Lea & Febiger, Philadelphia1980: 142-143
        • Twiggs LB
        • Potish RA
        Decision theory analysis of the enteric morbidity and surgical staging in the treatment of advanced cervical cancer.
        Am J Obstet Gynecol. 1984; 148: 134-140
        • Potish RA
        Radiation therapy of periaortic node metastases in cancer of the uterine cervix and endometrium.
        Radiology. 1987; 165: 567-570
        • Lee ET
        Statistical methods for survival data analysis. Lifetime Learning Publications, Belmont, California1980
        • Fletcher GH
        • Rutledge FN
        Extended field techniques in the management of cancers of the cervix.
        Am J Roentgenol. 1972; 114: 116-122
        • Berman ML
        • Keys H
        • Creasman W
        • DiSaia P
        • Bundy B
        • Blessing J
        Survival and patterns of recurrence in cervical cancer metastatic to periaortic lymph nodes (a Gyneco logic Oncology Group study).
        Gynecol Oncol. 1984; 19: 816
        • Griffiths CT
        Surgical resection of tumor bulk in the primary treatment of ovarian carcinoma.
        NCI Monogr. 1975; 42: 101
        • Dembo AJ
        Radiotherapeutic management of ovarian cancer.
        Semin Oncol. 1984; 11: 238
        • Burghart E
        • Pickel H
        • Stetner H
        Management of advanced ovarian cancer..
        Eur J Gynecol Oncol. 1984; 3: 155
        • Morrow CP
        • Shingleton HM
        • Averette HE
        • Webb MJ
        • Masterson JG
        • Morley GW
        Is pelvic radiaton beneficial in the postoperative management of stage IB squamous cell carcinoma of the cervix with pelvic node metastasis treated by radical hysterectomy and pelvic lymphadenectomy? A report from the Presidential Panel at the 1979 annual meeting of the Society of Gynecologic Oncologists.
        Gynecol Oncol. 1980; 10: 105