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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

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

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.

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Authors and Affiliations

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

    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 & Philippe Morice MD

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  1. Yann Delpech MD
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  2. Christine Haie-Meder MD
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  3. Annie Rey MD
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  4. Yaelle Zafrani MD
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  5. Catherine Uzan MD
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  6. Sebastien Gouy MD
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  7. Patricia Pautier MD
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  8. Catherine Lhommé MD
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  9. Pierre Duvillard MD
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  10. Damienne Castaigne MD
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  11. Philippe Morice MD
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Correspondence to Philippe Morice MD.

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Delpech, Y., Haie-Meder, C., Rey, A. et al. 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. Ann Surg Oncol 14, 3223–3231 (2007). https://doi.org/10.1245/s10434-007-9526-1

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  • DOI: https://doi.org/10.1245/s10434-007-9526-1

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