PRETREATMENT SURGICAL STAGING OF PATIENTS WITH CERVICAL-CARCINOMA - THE CASE FOR LYMPH-NODE DEBULKING

BACKGROUND. The routine use of extraperitoneal surgical staging prior to radiation therapy in patients with bulky or locally advanced cervic al carcinoma remains controversial. METHODS. A review was performed of 266 patients with cervical carcinoma who underwent extraperitoneal pe lvic and paraaortic lymphadenectomy prior to receiving radiotherapy. P atients were divided into groups based on their lymph node status. Gro up A had negative lymph nodes; Group B had resected, microscopic lymph node metastases; Group C had macroscopically positive lymph nodes tha t were resectable at the time of surgery; and Group D had unresectable lymph nodes. All patients received standard radiotherapy utilizing ex ternal beam and brachytherapy. Patients with lymph node metastases rec eived extended field irradiation. Survival probabilities were computed by the Kaplan-Meier product limits method with statistical significan ce determined by the Mantel-Cox log rank test.RESULTS, Lymph node meta stases were detected in 50% of patients. Five-and l0-year disease free survival rates were similar for all patients in Groups B and C. All p atients in Group D recurred. There was a 10.5% incidence of severe rad iation-related morbidity and a 1.1% incidence of treatment-related dea ths. CONCLUSIONS. Pretreatment extraperitoneal staging of patients wit h bulky or locally advanced cervical carcinoma may afford a survival b enefit via the debulking of macroscopically positive lymph nodes witho ut significantly increasing treatment-related morbidity or mortality. (C) 1998 American Cancer Society.