Isolated Para-Aortic Lymph Nodes Recurrence in Carcinoma Cervix

A Rashid,S Ghimire,S Hamid

doi:10.3126/jnhrc.v7i2.3016

Abstract

Background: To evaluate the presentation of isolated para-aortic lymph node recurrence after definitive treatment, and to analyze the effect of salvage treatment on the survival rate. Methods: A retrospective study was done for patients with invasive carcinoma of the uterine cervix treated with various modalities of treatment at Shaukat Khanum Memorial Cancer Hospital Research Center Lahore Pakistan from December, 1999 to August 2004. Results: The incidence of radiographically detected para aortic lymph node recurrence was 3.7% by FIGO stage at original diagnosis was 3 (50 %) in stage IIIB, 2 (33.3%) in post hysterectomy status and 1 (16.7%) in stage IB cervical carcinoma. Total 4 (66.7%) patients with para-aortic lymph nodes recurrences were identified with in the first 12 months after the initial treatment and 2(33.3%) had their recurrence after 12 month. Leg swelling, low back pain and hydronephrosis were observed when inquired for the presentation in those patients with recurrence in paraarotic lymph nodes. Hydronephrosis was the commonest finding (50%) either alone or in association with other symptoms. And 3 (50%) of the patient were died within two year of the diagnosis of recurrence.Three patients are still on follow up, one with progressive disease in liver and one with chronic renal failure, and one asymptomatic. Patient who received radiation alone had overall survival of 3.16 months after the recurrence compared with >12 months overall survival for those treated with chemotherapy. Conclusions: Symptoms like leg swelling, low back pain and hydronephrosis helps a lot to detect the early paraaortic recurrence, hydronephrosis being commonest. Although the number of patients with para-aortic recurrence were very small and the follow up time was too short to make any recommendations for salvage treatment or survival advantages, as a definitive treatment for isolated para aortic lymph nodes we can offer both radiotherapy or chemotherapy. Key words: cervix; carcinoma; lymph nodes; para-aortic; recurrence. DOI: 10.3126/jnhrc.v7i2.3016 Journal of Nepal Health Research Council Vol.7(2) Apr 2009 103-107

Highlights

Carcinoma of the uterine cervix has the highest incidence of gynecological cancers in Asia and is one of the most common cancers of the female genital tract.[1,2] Worldwide, nearly one-half million new diagnoses of, and an associated one-quarter million deaths from, invasive cervical cancer have been estimated to occur.[3,4] In the United States, 12,900 new diagnoses of, and an associated 4400 deaths from, cervical carcinoma have been estimated to occur annually.[5]
For the early detection of the recurrence we should kept in mind of the common symptoms like leg swelling, low back pain and hydronephrosis which are found to be the main pointers towards the disease and helps a lot to detect the early para-aortic recurrence, hydronephrosis being commonest
The number of patients with para-aortic recurrence were very small and the follow up time was too short to make any recommendations for salvage treatment or survival advantages, as a definitive treatment for isolated para aortic lymph nodes we can offer both radiotherapy or chemotherapy

Summary

Introduction

Carcinoma of the uterine cervix has the highest incidence of gynecological cancers in Asia and is one of the most common cancers of the female genital tract.[1,2] Worldwide, nearly one-half million new diagnoses of, and an associated one-quarter million deaths from, invasive cervical cancer have been estimated to occur.[3,4] In the United States, 12,900 new diagnoses of, and an associated 4400 deaths from, cervical carcinoma have been estimated to occur annually.[5] Early detection and improved radiation and surgical techniques used with in the past four decades in the management of this malignancy have resulted in better control of the pelvic tumor and longer patient survival These improved results have been accompanied by a higher incidence of distant metastases.6Definitive irradiation plays an important role in the treatment of these patients, especially those of an advanced stage. To evaluate the presentation of isolated para-aortic lymph node recurrence after definitive treatment, and to analyze the effect of salvage treatment on the survival rate

Methods

Results

Discussion

Conclusion