Abstract
From 1976 to 1989, 163 patients were treated by postoperative radiotherapy for cervical cancer Stage Ib and IIb, and the relation between of the degree of pelvic lymph node metastasis and the prognosis was investigated with and without para-aortic node irradiation.
Before the irradiation of mode, 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 patients (L1 and L2↑p<0.05), 73% for IIb L1 in 23 patients, 78% for IIb L2 in 9 patients, 47% for IIb L3 ↑in 18 patients (p<0.05). The prognosis was increasingly unfavorable with an increasing number of lymph node metastasis, and cases with bilateral lymph nodes involvement gives a less favorable prognosis than those with unilateral involvement. The first recurrent sites of Stage Ib were distant organ via lymphatic routes in 3 patients and hematogenous routes in 2 patients, and of IIb were via lymphatic routes in 10 patients, h ematogenous routes in 10 patients and regional recurrence in 6 patients.
After the 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 patients, 65% for Ib L3↑ in 9 patients (L1 and L3 ↑a p<0.01), 82% for IIB L1in 17 patients, 68% for IIb L2 in 27 patients, 48% for IIb L3 ↑ain 23 patients (L2 and L3↑p<0.01). 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 patients, the sites for IIb were via lymphatic routes in 10 patients, hematogenous 7 patients, peritonitis carcinomatousa 1 patient and in the pelvic field of 6 patients. Late effects developed in 3 cases (19%) of Ib and 19 cases (29%) of IIb. Side effects were increased with prophylactic para-aortic node irradiation. There was no significant difference in survival rates between pelvic and pelvic plus para-aortic node irradiation group.
Prophylactic para-aortic node irradiation for high risk patients is of limited value in preventing distant metastasis or improving survival rate. Patients with pelvic lymph node metastasis have a rather poor prognosis.
