Anatomic distribution and clinical target volume margin of para-aortic lymph node metastasis in cervical cancer / 中华放射肿瘤学杂志

ABSTRACT

Objective:To determine the regional boundary of para-aortic lymph node (PAN) metastasis in cervical cancer, and to explore the clinical target volume (CTV) margin.Methods:Eight-six patients with cervical cancer metastasis to PAN below and above left renal vein (LRV) were retrospectively included in this study. The anatomical relationship of the metastatic PANs and surrounding structures were analyzed according tocontrast-enhanced computed tomography (CT) and three dimensional reconstruction images.Results:Eight-six patients had metastatic PANs belowLRV metastatic nodes were located onthe medial side of ovarian vessels and ureters, behind the renal veins, duodenum, mesenteric vessels, in front of the anterior border of lumbar vertebra and psoas. The inferior mesenteric vein was close to the left anterior side of PANs. Where the duodenum appeared, no node was presenton the anterolateral side of the inferior vena cava (IVC).Above the LRV, 27 patients had retrocrural node involvement along the azygos and hemiazgos vein, and 25/27 cases were located below the junction level of cardia and oesophagus, and 5/27 patients had metastatic lymph nodes between IVC and the right crura of diaphragm, all below the level of coeliac trunk artery.Conclusions:CTV margin delineation of PAN below and above LRV is recommendedsuperiorly, the junction level of cardia and oesophagus; laterally, crura and the medial side of ovarian vessels and ureters and inferior mesenteric vein; anteriorly, the posterior side of the coeliac trunk artery and renal veins and duodenum, mesenteric vessels; posteriorly, the anterior border of lumbar vertebra and psoas.