Prospective Multicenter Study Evaluating the Survival of Patients With Locally Advanced Cervical Cancer Undergoing Laparoscopic Para-Aortic Lymphadenectomy Before Chemoradiotherapy in the Era of Positron Emission Tomography Imaging

Author:

Gouy Sebastien1,Morice Philippe1,Narducci Fabrice1,Uzan Catherine1,Martinez Alejandra1,Rey Annie1,Bentivegna Enrica1,Pautier Patricia1,Deandreis Desiree1,Querleu Denis1,Haie-Meder Christine1,Leblanc Eric1

Affiliation:

1. Sebastien Gouy, Philippe Morice, Catherine Uzan, Annie Rey, Enrica Bentivegna, Patricia Pautier, Desiree Deandreis, and Christine Haie-Meder, Institut Gustave Roussy; Sebastien Gouy, Philippe Morice, Catherine Uzan, Unit L'Institut National de la Santé et de la Recherche Médicale U10-30, Villejuif; Philippe Morice, University Paris Sud, Le Kremlin-Bicêtre; Fabrice Narducci and Eric Leblanc, Centre Oscar Lambret, Lille; Alejandra Martinez and Denis Querleu, Institut Claudius Regaud, Toulouse, France.

Abstract

Purpose The aim of this prospective study conducted in three French comprehensive cancer centers was to evaluate the therapeutic impact on survival of laparoscopic para-aortic (PA) staging surgery in locally advanced cervical cancer (LACC) before chemoradiotherapy. Patients and Methods We conducted a prospective multicenter study of 237 patients treated from 2004 to 2011 for LACC with negative positron emission tomography (PET) imaging of the PA area and undergoing laparoscopic PA lymphadenectomy. Radiation fields were extended to the PA area when PA nodes were involved. Chemoradiotherapy modalities were homogeneous across institutions. Patients with a poor prognosis histologic subtype or peritoneal carcinosis were excluded. Results Patients had clinical International Federation of Gynecology and Obstetrics stages IB2 (n = 79), IIA (n = 10), IIB (n = 121), III (n = 22), or IVA (n = 5). One hundred ninety-nine patients had squamous carcinoma, and 38 had adenocarcinoma/adenosquamous lesions. Twenty-nine patients (12%) had nodal involvement (false-negative PET–computed tomography [CT] results)—16 with a PA nodal metastasis measuring more than 5 mm and 13 with a nodal metastasis measuring ≤ 5 mm. Event-free survival rates at 3 years in patients without PA involvement or with PA metastasis measuring ≤ or more than 5 mm were 74% (SE, 4%), 69% (SE, 21%), and 17% (SE, 14%; P < .001). Conclusion To our knowledge, this is the largest series of patients reported undergoing such a strategy. We obtained the same survival rate for patients with PA nodal metastasis ≤ 5 mm and patients without PA lymph node involvement, suggesting that this strategy is highly efficient in such patients. Conversely, the survival of patients with PA nodal involvement greater than 5 mm remained poor, despite the absence of extrapelvic disease on PET-CT imaging in this subgroup.

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

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