Topographic mapping of pelvic and aortic lymph node metastases in stage IIIC1r locally advanced cervical cancer: A retrospective study by the Spain-GOG group.

OBJECTIVE

Lymph node (LN) metastasis is a key prognostic factor in locally advanced cervical cancer (LACC), especially at the aortic level. Prophylactic extended-field radiotherapy (EFRT) indications are being evaluated, as imaging (r) may miss low-volume aortic LN disease in patients with pelvic LN metastasis. Our aim was to describe the distribution of pelvic and aortic LN metastasis confirmed by histology in patients with FIGO stage IIIC1r LACC.

METHODS

This multicenter retrospective study included women with FIGO stage IIIC1r LACC treated with chemoradiotherapy and pretherapeutic nodal surgical staging with laparoscopic extraperitoneal aortic lymphadenectomy to the left renal vein and debulking of pathological pelvic LN on imaging. Imaging for stage IIIC1r diagnosis included MRI and/or PET-scan. LN metastasis distribution was categorized by location: pelvic or aortic and supra- or inframesenteric.

RESULTS

We included 164 patients, 96.3 % evaluated with MRI and 35 % with PET-scan. The median number of excised LN was 12 aortic and 8.5 pelvic. Pelvic LN metastasis was confirmed in 73 patients (44.5 %), of whom 31 (42.5 %) had aortic LN metastasis: 24.7 % inframesenteric, 4.1 % supramesenteric, and 13.7 % both. Pelvic LN were negative in 96 patients (58.5 %), of whom 11 (11.5 %) had aortic LN metastasis: 7.3 % inframesenteric, 3.1 % supramesenteric, and 1 % both.

CONCLUSIONS

In stage IIIC1r LACC, pelvic LN metastasis are confirmed in less than 50 % of patients following surgical evaluation. The risk of aortic LN involvement is higher when there are metastases at the pelvic level but not exclusively. The rate of supramesenteric disease supports extending the EFRT to the left renal vein.