Assessment of retroperitoneal lymph node status in locally advanced cervical cancer

Abstract Background The assessment of retroperitoneal lymph node status in patients with locally advanced cervical cancer is still a problem. This study aimed to explore the choice of these assessment methods. Methods Laparoscopic retroperitoneal lymphadenectomy was performed in 96 patients with advanced cervical cancer. The positive rates of lymph node metastasis were analyzed. The values of computed tomography lymph node minimum axial diameter (MAD) and squamous cell carcinoma antigen (SCC-Ag), and their combination in predicting retroperitoneal lymph node metastasis were compared. High-risk factors for common iliac lymph node (CILN) and/or para-aortic lymph node (PALN) metastasis were analyzed. Results The lymph node metastasis rate was 62.50% and the CILN and/or PALN metastasis rate was 31.25%. Overall, 96 patients had 172 visible lymph nodes. The positive rate of lymph node metastasis was significantly higher in the MAD ≥1.0 cm group (83.33%) than in the 0.5 cm ≤ MAD < 1.0 cm group (26.82%). The critical values of MAD and SCC-Ag in determining lymph node metastasis were 1.0 cm and 5.2 ng/mL, respectively. The accuracy, specificity, and Youden index of MAD ≥1.0 cm combined with SCC-Ag ≥ 5.2 ng/mL for evaluating lymph node metastasis were 75.71%, 100%, and 0.59, respectively, and were significantly different from the values for the MAD ≥1.0 cm (72.09%, 80.56%, and 0.47, respectively) and SCC-Ag ≥ 5.2 ng/mL (71.43%, 68.97%, and 0.42, respectively) groups. Correlation analysis showed that non-squamous cell carcinoma, pelvic lymph node (PLN) MAD ≥1.0 cm plus number ≥ 2, and 1 PLN MAD ≥1.0 cm with CILN and/or PALN MAD 0.5–1.0 cm were risk factors for CILN and/or PALN metastasis. Conclusion Patients with MAD ≥1.0 cm and SCC-Ag ≥ 5.2 ng/mL, as well as high risk factors for CILN and/or PALN metastasis, should undergo resection of enlarged lymph nodes below the common iliac gland and lymphadenectomy of CILN/PALN to reduce tumor burden and to clarify lymph node metastasis status for accurate guidance in follow-up treatment. Patients with MAD < 1.0 cm and SCC-Ag < 5.2 ng/mL may be treated with chemoradiotherapy directly based on imaging, given the low lymph node metastasis rate.

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Patterns of lymph node metastasis in locally advanced cervical cancer

Medicine ◽

10.1097/md.0000000000004814 ◽

2016 ◽

Vol 95 (39) ◽

pp. e4814 ◽

Cited By ~ 9

Author(s):

Zhikai Liu ◽

Ke Hu ◽

An Liu ◽

Jie Shen ◽

Xiaorong Hou ◽

...

Keyword(s):

Cervical Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Locally Advanced ◽

Advanced Cervical Cancer ◽

Locally Advanced Cervical Cancer ◽

Node Metastasis

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How should we stage and tailor treatment strategy in locally advanced cervical cancer? Imaging versus para-aortic surgical staging

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-001351 ◽

2020 ◽

Vol 30 (9) ◽

pp. 1434-1443

Author(s):

Alejandra Martinez ◽

Martina Aida Angeles ◽

Denis Querleu ◽

Gwenael Ferron ◽

Christophe Pomel

Keyword(s):

Cervical Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Lymph Nodes ◽

Locally Advanced ◽

Surgical Staging ◽

Advanced Cervical Cancer ◽

Locally Advanced Cervical Cancer ◽

Node Metastasis ◽

Pet Ct

Para-aortic lymph node status at initial assessment is the most important prognostic factor and a key point for the therapeutic strategy in patients with locally advanced cervical cancer. Undiagnosed lymph node metastasis is a major clinical problem as the finding of positive para-aortic lymph nodes leads to treatment modification, with a possible impact on disease free survival. When aortic lymph node disease is discovered, radiotherapy is extended to the para-aortic area, and other treatment modalities may be considered. Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) is the most accurate imaging examination to assess para-aortic extension in patients with locally advanced cervical cancer. The gold standard to identify para-aortic extension remains histologic evaluation of the lymph nodes. Indeed, PET/CT fails to detect approximately 10–15% of patients with negative PET/CT aortic nodes who have lymph node metastasis on pathologic staging. Patients with positive pelvic lymph nodes have para-aortic extension in 25–30% of cases, and surgical staging will lead to treatment modification and probably to improved para-aortic and distant control. Surgical staging also avoids unnecessary toxicity associated with extended field radiation in approximately 75% of patients with pelvic lymph node metastasis. The best modality to identify para-aortic extension is histological evaluation of the lymph nodes, but the survival benefit of surgical staging remains controversial. On the other hand, current studies include a majority of patients without pelvic lymph node spread, who are likely to be those who will benefit the least from surgical staging.

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Utility of PET-CT to evaluate retroperitoneal lymph node metastasis in advanced cervical cancer: Results of ACRIN6671/GOG0233 trial

Gynecologic Oncology ◽

10.1016/j.ygyno.2016.05.002 ◽

2016 ◽

Vol 142 (3) ◽

pp. 413-419 ◽

Cited By ~ 27

Author(s):

Mostafa Atri ◽

Zheng Zhang ◽

Farrokh Dehdashti ◽

Susanna I. Lee ◽

Shamshad Ali ◽

...

Keyword(s):

Cervical Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Advanced Cervical Cancer ◽

Retroperitoneal Lymph Node ◽

Node Metastasis ◽

Pet Ct

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Utility of preoperative ferumoxtran-10 MRI to evaluate retroperitoneal lymph node metastasis in advanced cervical cancer: Results of ACRIN 6671/GOG 0233

European Journal of Radiology Open ◽

10.1016/j.ejro.2014.11.002 ◽

2015 ◽

Vol 2 ◽

pp. 11-18 ◽

Cited By ~ 5

Author(s):

Mostafa Atri ◽

Zheng Zhang ◽

Helga Marques ◽

Jeremy Gorelick ◽

Mukesh Harisinghani ◽

...

Keyword(s):

Cervical Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Advanced Cervical Cancer ◽

Retroperitoneal Lymph Node ◽

Node Metastasis

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Efficacy and toxicity of chemoradiation with image-guided adaptive brachytherapy for locally advanced cervical cancer

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2018-000057 ◽

2019 ◽

Vol 29 (2) ◽

pp. 257-265 ◽

Cited By ~ 2

Author(s):

Nanda Horeweg ◽

Carien L Creutzberg ◽

Eva C Rijkmans ◽

Mirjam S Laman ◽

Laura A Velema ◽

...

Keyword(s):

Risk Factors ◽

Cervical Cancer ◽

Lymph Node ◽

Treatment Failure ◽

Locally Advanced ◽

Advanced Cervical Cancer ◽

Locally Advanced Cervical Cancer ◽

Image Guided ◽

Node Metastasis

ObjectiveTo evaluate the efficacy and toxicity of primary chemoradiation with image-guided adaptive brachytherapy for locally advanced cervical cancer and to identify predictors of treatment failure and toxicity.MethodsRetrospective analysis of 155 stage IB-IVA cervical cancer patients treated from 2008 to 2016 with chemoradiation and image-guided adaptive brachytherapy. Treatment consisted of external beam radiotherapy (45 – 48.6 Gy in 1.8 – 2 Gy fractions) with concurrent weekly cisplatin (40 mg/m2, 5 – 6 cycles) and image-guided adaptive brachytherapy (3−4 × 7 Gy high dose rate) using intracavitary or combined intracavitary-interstitial techniques according to GEC-ESTRO (Group Européen de Curiethérapie and the European Society for Radiotherapy and Oncology) recommendations. Incidences of all outcomes were calculated using Kaplan-Meier’s methodology. Risk factors for treatment failure and toxicity were identified using Cox’s proportional hazards model and the Kruskal-Wallis H-test respectively.ResultsMedian follow-up was 57 months. Five-year local control was 90.4 %. Five-year para-aortic lymph node metastasis-free and distant metastasis-free survival were 85.3 % and 70.2 % respectively. Tumor size and lymph node metastasis were independent risk factors for treatment failure. Cumulative incidences of severe late bladder, rectal, bowel, and vaginal toxicity were 0.8%, 3.3%, 3.6%, and 1.4% respectively at 5 years of follow-up. Combined intracavitary-interstitial brachytherapy techniques were associated with less vaginal morbidity.ConclusionsPrimary chemoradiation with image-guided adaptive brachytherapy for locally advanced cervical cancer is a highly effective local and loco-regional treatment. However, survival is compromised by the occurrence of distant metastasis. Patients with large tumors and nodal involvement at diagnosis are at increased risk and may benefit from intensified treatment. Severe late gastrointestinal and urogenital toxicity is limited and may be further reduced by increasing conformity, using combined intracavitary-interstitial techniques and lowering doses to organs at risk.

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