Significance of prophylactic para-aortic lymph node irradiation in the postoperatic treatment of the cervical cancer. Relationship between prognosis and lymph node metastasis

Between 1976 and 1989, 163 patients were treated by postoperative radiotherapy for cervical cancer stage Ib and IIb. Before irradiation for the whole pelvis, a total dose of 50 Gy was given in 5 weeks. Cumulative 5-year survival rates according to the number of pelvic lymph node metastasis were 100% for Ib L1 (one node involvement) in 10 patients, 60% for Ib L2 ↑ (two or more involved) in 10, 73% for IIb L1 in 23, 78% for IIb L2 in 9, 47% for IIb L3 ↑ in 18. The first recurrent sites of stage Ib were distant organ via lymphatic routes in 3 patients and hematogenous routes in 2. IIb were via lymphatic routes in 10 patients, hematogenous routes in 10, and regional recurrence in 6. After introduced para-aortic node irradiation, the pelvic plus para-aortic irradiation delivered 45 Gy in 5 weeks for two or more lymph nodes involvement. The cumulative 5-year survival rates were 100% for Ib L1 in 10 patients, 100% for Ib L2 in 7, 65% for Ib L3 ↑ in 9, 82% for IIb L1 in 17, 68% for IIb L2 in 27, and 48% for IIb L3 ↑ in 23. The first recurrent sites for Ib with introduction of para-aortic node irradiation were distant organs via lymphatic routes in 1 patient and hematogenous routes in 2, and the sites for IIb were via lymphatic routes in 10, hematogenous 7, peritonitis carcinomatous 1, and in the pelvic field of 6. Late effects developed in 3 (19%) of Ib and 19 (29%) of IIb. Side effects increased with prophylactic para-aortic node irradiation. No significant difference was observed in survival rates between pelvic and pelvic plus para-aortic node irradiation group. (S.Y.)