Incidence of lymph node metastases in locally advanced cervical cancer in figo stage ib2-iib - the role of preoperative radiotherapy

Abstract

This study aims at determining the incidence rate, number, location and type of lymph node metastases in patients with cervical cancer in stage IB2 and IIB as classified by FIGO prior to and after radiotherapy. Between 2003 and 2011, 184 patients with cervical cancer in FIGO clinical stage IB2-IIB were operated on in the Clinic of Gynaecology, St. Anna University Hospital of Varna. Surgery consisted in radical hysterectomy type III and LEP procedure in most cases. Radiotherapy was performed either preoperatively 30 Gy TGT and postoperatively until 52 Gy, or postoperatively - 52 Gy TGT. All the patients were divided into 4 groups according to the stage and order of procedures: group one - 83 patients in stage IB2 with primary surgery; group two - 11 patients in stage IB2 with preoperative radiotherapy and surgery; group three - 31 patients in stage IIB with primary surgery, and group four - 50 patients in stage IIB with preoperative radiotherapy and surgery. The incidence rate of lymph node metastases in these groups was 37.3%, 9%, 38.7%, and 22%, respectively. The incidence rate of macro metastases in lymph nodes in these groups was 20.4%, 9%, 25.8%, and 12%, respectively. Preoperative radiotherapy reduced the incidence rate of lymph node metastases in locally advanced cervical cancer in FIGO stage IB2-IIB. In these patients, lumbosacral, pre-sacral, and para-aortic lymph node dissection should be performed alongside the pelvic lymph node dissection to minimize the risk of distant metastases. The lymph node dissection occupied a central place in the surgical treatment of these patients. In addition to its therapeutic effects, it played a staging role that determined the most appropriate adjuvant treatment. Scripta Scientifica Medica 2012; 44(2): 65-67.