Para-aortic plus pelvic lymphadenectomy in locally advanced cervical cancer: A single institutional experience

Mezquita, G; Muruzábal, Juan Carlos; Pérez, B.; Aguirre, Sara; Villafranca, E.; Jurado, M.

doi:10.1016/j.ejogrb.2019.02.033

Cited by 13 publications

(14 citation statements)

References 30 publications

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“…The role of LND in local control and distant metastasis for locally advanced cervical cancer remains uncertain. There are reports that LND improves local control and decreases extra-pelvic failures in patients with metastases [ 21 22 ]. We hypothesize that the survival benefit for LND is limited due to the natural history of cervical cancer and the treatment effect of RT.…”

Section: Discussionmentioning

confidence: 99%

Surgical or imaging lymph node assessment in locally advanced cervical cancer: a systematic review and meta-analysis

et al. 2020

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Objective To evaluate the survival impact of imaging vs surgical nodal assessment in patients with cervical cancer stage IB2–IVA prior to definitive chemoradiotherapy (CRT). Methods PubMed, MEDLINE, Cochrane Library, and ClinicalTrials.gov were used to search for publications in English and Chinese over a 50-year period. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols was used to conduct this review. Inclusion criteria were studies that compared survival outcomes in International Federation of Gynecology and Obstetrics 2009 stage IB2–IVA cervical cancer patients with pre-therapy pelvic and/or aortic lymphadenectomy (LND) or imaging. One or more of the following modalities were used for nodal assessment: computed tomography (CT), magnetic resonance imaging, or positron emission tomography-CT. The National Institutes of Health Quality Assessment Tool was utilized to assess study quality. Results The initial search identified 65 studies, and five met the inclusion criteria. There were a total of 1,112 patients. Seven hundred and fifty-four underwent pelvic and/or aortic LND and 358 had imaging. When compared to LND, imaging had a sensitivity and specificity of 88.9% and 22.2% for pelvic lymph node (LN), and 33%–62.5% and 92%–95.5% for para-aortic LN. There were no differences in progression-free survival (PFS) (hazard ratio [HR]=1.13; 95% confidence interval [CI]=0.73–1.74; I 2 =75%; p<0.01) and overall survival (OS) (HR=1.06; 95% CI=0.66–1.69; I 2 =75%; p<0.01) between surgical and imaging nodal assessment. Conclusions Imaging and surgical nodal assessment has comparable PFS and OS in patients with cervical cancer stage IB2–IVA. Trial Registration PROSPERO Identifier: CRD42020155486

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Section: Discussionmentioning

confidence: 99%

Surgical or imaging lymph node assessment in locally advanced cervical cancer: a systematic review and meta-analysis

et al. 2020

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“…These articles were not part of the initial search result, because the title nor abstract included the 'lymphadenectomy' search term or synonyms. The final analysis included 16 studies [14,15,18,19,[25][26][27][28][29][30][31][32][33][34][35][36] reporting on 18 cohorts which were suitable for quantitative meta-analysis with pooling of upstaging outcomes.…”

Section: Identification Of Studiesmentioning

confidence: 99%

“…Characteristics of the 18 cohorts within 16 studies included in the quantitative synthesis are outlined in Table 2. Six studies [15,25,27,29,30,35] (38%) were prospective and 10 studies [14,18,19,26,28,[31][32][33][34]36] (63%) were retrospective by design. All studies used laparoscopic procedures.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Upstaging by para-aortic lymph node dissection in patients with locally advanced cervical cancer: A systematic review and meta-analysis

Thelissen

Jürgenliemk-Schulz

Leij

et al. 2022

Gynecologic Oncology

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Para-aortic lymph node (PALN) status in locally advanced cervical cancer has therapeutic and prognostic implications.• Reported proportions in literature of upstaging by PALN dissection after negative PALN imaging were meta-analyzed.• After negative PET or PET-CT, PALN dissection yielded pathologic PALNs in 12% of all patients.• After negative MRI or CT, PALN dissection yielded pathologic PALNs in 11% of all patients.• After PET-CT showed pelvic nodal (but no PALN) involvement, PALN dissection yielded pathologic PALNs in 21% of patients.

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“…Ramirez reported that 18.3% of patients had a treatment modification based on surgical findings ( 21 ). Mezquita et al ( 73 ) reported that 13.4% of patients had treatment modification to the para-aortic area after surgical staging.…”

Section: Surgical Staging Of Paln Regionmentioning

confidence: 99%

Prophylactic Extended-Field Irradiation in Patients With Cervical Cancer: A Literature Review

et al. 2020

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Currently, the standard radiation field for locally advanced cervical cancer patients without evidence of para-aortic lymph node (PALN) metastasis is the pelvis. Due to the low accuracy of imaging in the diagnosis of PALN metastasis and the high incidence of PALN failure after pelvic radiotherapy, prophylactic pelvic and para-aortic irradiation, also called extended-field irradiation (EFI), is performed for patients with cervical cancer. In the era of concurrent chemoradiotherapy, randomized controlled trials are limited, and whether patients with cervical cancer can benefit from prophylactic EFI is still controversial. With conformal or intensity-modulated radiation therapy, patients tolerate prophylactic EFI very well. The severe toxicities of prophylactic EFI are not significantly higher than those of pelvic radiotherapy. We recommend delivering prophylactic EFI to cervical cancer patients with common iliac lymph nodes metastasis. Clinical trials are needed to investigate whether patients with ≥3 positive pelvic lymph nodes and FIGO stage IIIB disease can benefit from prophylactic EFI. According to the distribution of PALNs, it is reasonable to use the renal vein as the upper border of the radiation therapy field for patients treated with prophylactic EFI. The clinical target volume expansion of the node from the vessel should be smaller in the right para-caval region than in the left lateral para-aortic region. The right para-caval region above L2 or L3 may be omitted from the PALN target volume to reduce the dose to the duodenum. More clinical trials on prophylactic EFI in cervical cancer are needed.

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Para-aortic plus pelvic lymphadenectomy in locally advanced cervical cancer: A single institutional experience

Cited by 13 publications

References 30 publications

Surgical or imaging lymph node assessment in locally advanced cervical cancer: a systematic review and meta-analysis

Surgical or imaging lymph node assessment in locally advanced cervical cancer: a systematic review and meta-analysis

Upstaging by para-aortic lymph node dissection in patients with locally advanced cervical cancer: A systematic review and meta-analysis

Prophylactic Extended-Field Irradiation in Patients With Cervical Cancer: A Literature Review

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