Discussion on the Necessity of Bilateral Inguinal Lymphatic Area Irradiation for Cervical Cancer with Invasion of the Lower One Third of Vagina

Background The rate of inguinal lymph node metastasis is relatively low in cervical cancer patients.According to the NCCN (National Comprehensive Cancer Network) guidelines for cervical cancer,patients with cervical cancer invading the lower 1/3 of the vagina require bilateral inguinal lymphatic area preventive irradiation. But do they need preventive inguinal area irradiation? Methods A total of 184 patients with cervical cancer accompanied by the lower 1/3 of the vagina invasion were selected as the study subjects.In this study, a trial and control method was used to select 180 patients without inguinal lymph node metastasis.The patients were divided into preventive radiotherapy group (109 cases) and non-preventive radiotherapy group (71 cases). During and after treatment, the occurrence of inguinal skin damage, lower extremity edema and femoral head necrosis was observed. Results Thirteen cases (7.07%) of 184 patients were found with inguinal lymph node enlargement by imaging examination, and only 4 cases (2.17%) were further confirmed by pathology.In prophylaxis irradiation group, there were 26(23.85%) cases of side injury.In the follow-up of two groups after treatment there was no recurrence in the inguinal lymph nodes. Conclusion The inguinal lymph node metastasis rate in patients with cervical cancer invading the lower third of the vagina is 2.17%.In order to avoid such a low incidence, we carry out preventive irradiation, which will cause 23.85% of local secondary injuries .And even if we do not perform preventive inguinal lymph node irradiation, there is no difference in the recurrence rate of inguinal lymph nodes between the two groups. Preventive inguinal lymph node irradiation isn’t necessary for these patients.