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Multicenter Study
. 2016 May;293(5):1081-6.
doi: 10.1007/s00404-015-3885-9. Epub 2015 Sep 18.

Para-aortic workup in locally advanced cervical cancer: heterogeneity is still the rule. Results from a retrospective multicenter study

Elodie Chantalat  1 , Fabien Vidal  2 , Pierre Leguevaque  3 , Benoît Lepage  4 , Eric Lambaudie  5 , Thomas Hebert  6 , Stéphanie Motton  3
Affiliations
Multicenter Study

Para-aortic workup in locally advanced cervical cancer: heterogeneity is still the rule. Results from a retrospective multicenter study

Elodie Chantalat et al. Arch Gynecol Obstet. 2016 May.

Abstract

Purpose: We retrospectively studied the different strategies of para-aortic (PA) staging of patients with PA involvement in locally advanced cervical cancer as conducted in eight centers in France and their impact upon survival and management.

Methods: All patients enrolled in this multicenter study presented with cervical cancer with PA involvement. The diagnosis of PA spread was based on imaging assessment of the PA area and/or pathological examination of harvested PA lymph nodes when staging lymphadenectomy was performed. Imaging modalities comprised positron emission tomography (PET), magnetic resonance imaging and/or computed tomography. Survival outcomes were evaluated retrospectively.

Results: One hundred and fifteen women were retrospectively studied. Radiological staging was conducted in 101 (87.8 %) patients. PET was performed in 66 patients (57.4 %). Its FN rate was 22.7 % (15/66) and its sensitivity 77.3 %. Para-aortic lymphadenectomy was conducted in a large proportion of patients (67.8 %). Its indications were not restricted to negative radiological workup. The lymphadenectomy rate was significantly higher in patients with earlier stages (p = 0.02) and lower tumor volume (p = 0.01). Treatment consisted of chemoradiation therapy with extended-field radiotherapy in all patients, followed by intracavitary brachytherapy in 94 cases (81.7 %) and completion surgery in 69 cases (60 %). Patients without para-aortic metastasis on radiological examination were more likely to receive all treatment modalities (p = 0.04).

Conclusion: Despite established recommendations, our results point out the tremendous heterogeneity regarding para-aortic assessment. These differences in management are perhaps related to a recommended therapeutic strategy that does not appear to improve the poor prognosis associated with PA involvement.

Keywords: Cervical cancer; Lymphadenectomy; Para-aortic involvement; Para-aortic staging.

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