CERVICAL-CANCER WITH PARAAORTIC METASTASES - SIGNIFICANCE OF RESIDUALPARAAORTIC DISEASE AFTER SURGICAL STAGING

Cervical carcinoma frequently metastasizes to the paraaortic region, n ecessitating extended field radiotherapy to effect a cure. As imaging modalities are unreliable in identifying all cases of paraaortic nodal metastases (PAN), surgical staging is often utilized prior to radioth erapy. This study was aimed at identifying factors predictive of survi val in women with cervical carcinoma and paraaortic metastases. In par ticular, survival based on extent of paraaortic disease was examined. The study group consisted of 43 women (stages IB-IVB) identified betwe en 1982 and 1993 who were treated with extended field radiation for ce rvical carcinoma with histologically confirmed paraaortic metastases. The estimated 5-year survival for the study population was 24% with a median survival of 18 months. Pelvic tumor size had a significant impa ct on survival with the median survival being 34 months if the primary lesion was <6 cm compared to 14 months if greater than or equal to 6 cm (P = 0.01). Eight of the 26 (31%) women without residual PAN diseas e after surgical staging remain alive and disease free (mean followup, 74 months). In contrast, only 1 of the 17 (6%) women with gross resid ual PAN is alive 71 months after treatment (P = 0.05). However, a comp arison of Kaplan-Meier survival curves did not show a statistically si gnificant advantage to the surgical excision of grossly involved PAN ( P = 0.98). Although long-term survival among women with grossly involv ed, unresected paraaortic metastases is uncommon, further study is nec essary to elucidate the role of surgical excision of bulky aortic dise ase in women with cervical cancer. (C) 1998 Academic Press.