Pretreatment surgical staging of patients with cervical carcinoma: The case for lymph node debulking

Jonathan A. Cosin, Jeffrey M. Fowler, M. Dwight Chen, Pamela J. Paley, Linda F. Carson, Leo B. Twiggs

Research output: Contribution to journalArticle

189 Citations (Scopus)

Abstract

BACKGROUND. The routine use of extraperitoneal surgical staging prior to radiation therapy in patients with bulky or locally advanced cervical carcinoma remains controversial. METHODS. A review was performed of 266 patients with cervical carcinoma who underwent extraperitoneal pelvic and paraaortic lymphadenectomy prior to receiving radiotherapy. Patients were divided into groups based on their lymph node status. Group A had negative lymph nodes; Group B had resected, microscopic lymph node metastases; Group C had macroscopically positive lymph nodes that were resectable at the time of surgery; and Group D had unresectable lymph nodes. All patients received standard radiotherapy utilizing external beam and brachytherapy. Patients with lymph node metastases received extended field irradiation. Survival probabilities were computed by the Kaplan-Meier product limits method with statistical significance determined by the Mantel-Cox log rank test. RESULTS. Lymph node metastases were detected in 50% of patients. Five- and 10-year disease free survival rates were similar for all patients in Groups B and C. All patients in Group D recurred. There was a 10.5% incidence of severe radiation-related morbidity and a 1.1% incidence of treatment-related deaths. CONCLUSIONS. Pretreatment extraperitoneal staging of patients with bulky or locally advanced cervical carcinoma may afford a survival benefit via the debulking of macroscopically positive lymph nodes without significantly increasing treatment-related morbidity or mortality.

Original languageEnglish
Pages (from-to)2241-2248
Number of pages8
JournalCancer
Volume82
Issue number11
DOIs
StatePublished - Jun 1 1998
Externally publishedYes

Fingerprint

Lymph Nodes
Carcinoma
Radiotherapy
Neoplasm Metastasis
Morbidity
Survival
Incidence
Brachytherapy
Kaplan-Meier Estimate
Lymph Node Excision
Disease-Free Survival
Survival Rate
Radiation
Mortality
Therapeutics

Keywords

  • Cervical carcinoma
  • Extraperitoneal
  • Pretreatment
  • Radiation therapy
  • Surgical staging

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Pretreatment surgical staging of patients with cervical carcinoma : The case for lymph node debulking. / Cosin, Jonathan A.; Fowler, Jeffrey M.; Chen, M. Dwight; Paley, Pamela J.; Carson, Linda F.; Twiggs, Leo B.

In: Cancer, Vol. 82, No. 11, 01.06.1998, p. 2241-2248.

Research output: Contribution to journalArticle

Cosin, Jonathan A. ; Fowler, Jeffrey M. ; Chen, M. Dwight ; Paley, Pamela J. ; Carson, Linda F. ; Twiggs, Leo B. / Pretreatment surgical staging of patients with cervical carcinoma : The case for lymph node debulking. In: Cancer. 1998 ; Vol. 82, No. 11. pp. 2241-2248.
@article{5254aa5ebc3140389ed33bfeac8b2b88,
title = "Pretreatment surgical staging of patients with cervical carcinoma: The case for lymph node debulking",
abstract = "BACKGROUND. The routine use of extraperitoneal surgical staging prior to radiation therapy in patients with bulky or locally advanced cervical carcinoma remains controversial. METHODS. A review was performed of 266 patients with cervical carcinoma who underwent extraperitoneal pelvic and paraaortic lymphadenectomy prior to receiving radiotherapy. Patients were divided into groups based on their lymph node status. Group A had negative lymph nodes; Group B had resected, microscopic lymph node metastases; Group C had macroscopically positive lymph nodes that were resectable at the time of surgery; and Group D had unresectable lymph nodes. All patients received standard radiotherapy utilizing external beam and brachytherapy. Patients with lymph node metastases received extended field irradiation. Survival probabilities were computed by the Kaplan-Meier product limits method with statistical significance determined by the Mantel-Cox log rank test. RESULTS. Lymph node metastases were detected in 50{\%} of patients. Five- and 10-year disease free survival rates were similar for all patients in Groups B and C. All patients in Group D recurred. There was a 10.5{\%} incidence of severe radiation-related morbidity and a 1.1{\%} incidence of treatment-related deaths. CONCLUSIONS. Pretreatment extraperitoneal staging of patients with bulky or locally advanced cervical carcinoma may afford a survival benefit via the debulking of macroscopically positive lymph nodes without significantly increasing treatment-related morbidity or mortality.",
keywords = "Cervical carcinoma, Extraperitoneal, Pretreatment, Radiation therapy, Surgical staging",
author = "Cosin, {Jonathan A.} and Fowler, {Jeffrey M.} and Chen, {M. Dwight} and Paley, {Pamela J.} and Carson, {Linda F.} and Twiggs, {Leo B.}",
year = "1998",
month = "6",
day = "1",
doi = "10.1002/(SICI)1097-0142(19980601)82:11<2241::AID-CNCR20>3.0.CO;2-T",
language = "English",
volume = "82",
pages = "2241--2248",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "11",

}

TY - JOUR

T1 - Pretreatment surgical staging of patients with cervical carcinoma

T2 - The case for lymph node debulking

AU - Cosin, Jonathan A.

AU - Fowler, Jeffrey M.

AU - Chen, M. Dwight

AU - Paley, Pamela J.

AU - Carson, Linda F.

AU - Twiggs, Leo B.

PY - 1998/6/1

Y1 - 1998/6/1

N2 - BACKGROUND. The routine use of extraperitoneal surgical staging prior to radiation therapy in patients with bulky or locally advanced cervical carcinoma remains controversial. METHODS. A review was performed of 266 patients with cervical carcinoma who underwent extraperitoneal pelvic and paraaortic lymphadenectomy prior to receiving radiotherapy. Patients were divided into groups based on their lymph node status. Group A had negative lymph nodes; Group B had resected, microscopic lymph node metastases; Group C had macroscopically positive lymph nodes that were resectable at the time of surgery; and Group D had unresectable lymph nodes. All patients received standard radiotherapy utilizing external beam and brachytherapy. Patients with lymph node metastases received extended field irradiation. Survival probabilities were computed by the Kaplan-Meier product limits method with statistical significance determined by the Mantel-Cox log rank test. RESULTS. Lymph node metastases were detected in 50% of patients. Five- and 10-year disease free survival rates were similar for all patients in Groups B and C. All patients in Group D recurred. There was a 10.5% incidence of severe radiation-related morbidity and a 1.1% incidence of treatment-related deaths. CONCLUSIONS. Pretreatment extraperitoneal staging of patients with bulky or locally advanced cervical carcinoma may afford a survival benefit via the debulking of macroscopically positive lymph nodes without significantly increasing treatment-related morbidity or mortality.

AB - BACKGROUND. The routine use of extraperitoneal surgical staging prior to radiation therapy in patients with bulky or locally advanced cervical carcinoma remains controversial. METHODS. A review was performed of 266 patients with cervical carcinoma who underwent extraperitoneal pelvic and paraaortic lymphadenectomy prior to receiving radiotherapy. Patients were divided into groups based on their lymph node status. Group A had negative lymph nodes; Group B had resected, microscopic lymph node metastases; Group C had macroscopically positive lymph nodes that were resectable at the time of surgery; and Group D had unresectable lymph nodes. All patients received standard radiotherapy utilizing external beam and brachytherapy. Patients with lymph node metastases received extended field irradiation. Survival probabilities were computed by the Kaplan-Meier product limits method with statistical significance determined by the Mantel-Cox log rank test. RESULTS. Lymph node metastases were detected in 50% of patients. Five- and 10-year disease free survival rates were similar for all patients in Groups B and C. All patients in Group D recurred. There was a 10.5% incidence of severe radiation-related morbidity and a 1.1% incidence of treatment-related deaths. CONCLUSIONS. Pretreatment extraperitoneal staging of patients with bulky or locally advanced cervical carcinoma may afford a survival benefit via the debulking of macroscopically positive lymph nodes without significantly increasing treatment-related morbidity or mortality.

KW - Cervical carcinoma

KW - Extraperitoneal

KW - Pretreatment

KW - Radiation therapy

KW - Surgical staging

UR - http://www.scopus.com/inward/record.url?scp=0032104288&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032104288&partnerID=8YFLogxK

U2 - 10.1002/(SICI)1097-0142(19980601)82:11<2241::AID-CNCR20>3.0.CO;2-T

DO - 10.1002/(SICI)1097-0142(19980601)82:11<2241::AID-CNCR20>3.0.CO;2-T

M3 - Article

C2 - 9610705

AN - SCOPUS:0032104288

VL - 82

SP - 2241

EP - 2248

JO - Cancer

JF - Cancer

SN - 0008-543X

IS - 11

ER -