Role of extended para-aortic lymph nodes irradiation in the management of carcinoma of uterine cervix

ABSTRACT

This study included the analysis of 70 patients admitted to Radiotherapy and Oncology Unit, Faculty of Medicine, University of Alexandria with histologically proved carcinoma of the cervix and with positive pelvic with or without para-aortic lymph nodes as demonstrated by lymphography alone. Cases were treated radically by radiotherapy. External irradiation was delivered by extended field technique in groups 1 and 2, while in group 3 it was delivered to pelvic region only [group 1 para-aortic lymph nodes were treated therapeutically, while in group 2 it was prophylactically treated]. Treatment tolerance was approximately the same for all field sizes except when the field was extended to include the para-aortic region. Poor tolerance with severe nausea, vomiting and diarrhea requiring frequent interruption of irradiation was observed in 33.3% and 25% of cases of extended field group [group 1 and group 2, respectively] compared with 5.7% of cases in the pelvic group only [group 3], P <0.05. Such poor tolerance was more experienced in patients above the age of 50 years. The incidence of late complication was more pronounced in group 1 and group 2 compared with that of group 3 [48.5% versus 34%, respectively], P >0.05. Nominal st and ard dose [NSD] and biological effective dose [BED] were calculated for extended field groups 1 and 2. Para-aortic treatment failures were 14.2% in groups 1 and 2 versus 17.2% in group 3 [P >0.05]. Locoregional treatment was not found to influence the incidence of distant metastasis, the latter were nearly the same in all treatment groups. Furthermore, there was no significant difference in the overall and disease free survival results among the different therapeutic groups included