IS THERE STILL A ROLE FOR LYMPHOGRAPHY IN THE MANAGEMENT OF EARLY-STAGE CARCINOMA OF THE CERVIX

The value of lymphography in the management of carcinoma of the cervix is controversial and in many institutions has ceased to be used as pa rt of routine staging. We present the results of 103 patients with car cinoma of the cervix treated by radical radiotherapy alone at the Roya l Marsden Hospital between 1984 and 1990 all of whom had a staging lym phogram and computed tomography (CT) of the abdomen and pelvis as part of their routine staging prior to therapy. Our results show that 72 p atients (70%) had no involved nodes detected on either CT or lymphogra phy (LG - ve/CT - ve) while 16 patients (15.5%) were thought to have i nvolved lymph nodes on lymphography alone but not on CT (LG + ve/CT - ve). The remaining 15 cases (14.5%) had involved lymph nodes on both C T and lymphography (LG + ve/CT + ve). There were no patients shown to have involved lymph nodes on CT with a negative lymphogram. Survival a nalysis on these three groups showed that patients in the LG + ve/CT ve group did worse than the other two groups with only a 28% 5 year s urvival compared with 60% (LG - ve/CT - ve group) and 64% (LG + ve/CT - ve group) (p < 0.1). This effect of lymph node involvement disappear ed in a multivariate analysis using Cox regression when stage came out as the strongest factor affecting survival. After controlling for sta ge, a further analysis of patients with only stage I and II disease ha s shown that patients who were LG + ve/CT + ve still did significantly (p < 0.05) worse (30% 5 year survival) than the other two groups: LC - ve/CT - ve (62% 5 year survival) and LG + ve/CT - ve (78% 5 year sur vival). The lymphogram result in the LG + ve/CT - ve group altered cli nical management in 5/6 patients with stage I or IIA disease who avoid ed radical surgery and who were given a parametrial boost to the site of lymph node involvement. The possible benefit of this additional tre atment to explain the higher survival rate of patients in the LG + ve/ CT - ve group is discussed further. We conclude that lymphography stil l has a limited role to play in patients with early stage disease (I o r IIA) who do not appear to have involved lymph nodes on CT scanning.