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

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

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.

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Acknowledgments

We would like to thank P Mathevet (Suisse), Xavier Montbarbon (Lyon), M Deslandres (Toulouse), Yves Aubard (Limoges), Vanessa Conri (Bordeaux), Jean-Marc Classe, Isabelle Jaffre, Emmanuelle Jougla (Nantes), Benedicte Groff (Strasbourg) and Nina Crowte for technical support.

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Authors and Affiliations

  1. Department of Gynecological Surgery, CHU Rangueil, Toulouse, France

    Elodie Chantalat, Pierre Leguevaque & Stéphanie Motton

  2. Department of Gynecological Surgery, CHU Purpan, Toulouse, France

    Fabien Vidal

  3. Department of Epidemiology, CHU Rangueil, Toulouse, France

    Benoît Lepage

  4. Department of Gynecological Surgery, Institut Paoli-Calmettes, Marseille, France

    Eric Lambaudie

  5. Department of Gynecological Surgery, CHU Bretonneau, Tours, France

    Thomas Hebert

Authors
  1. Elodie Chantalat
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  2. Fabien Vidal
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  3. Pierre Leguevaque
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  4. Benoît Lepage
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  7. Stéphanie Motton
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Correspondence to Elodie Chantalat.

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The authors declare that they have no conflict of interest, and they have no financial relationship with the organization that sponsored the research.

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Chantalat, E., Vidal, F., Leguevaque, P. et al. Para-aortic workup in locally advanced cervical cancer: heterogeneity is still the rule. Results from a retrospective multicenter study. Arch Gynecol Obstet 293, 1081–1086 (2016). https://doi.org/10.1007/s00404-015-3885-9

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