Clinical Results of Lymphography in Cancer of the Uterine Cervix. A Retrospective Study of 542 Consecutive, Unselected Patients

Diagnostic and Prognostic Value of Lymphography in Patients with Cancer of the Endometrium

The results of foot lymphography in 161 patients with endometrial carcinoma, observed from 1968 to 1977 at the Istituto Nazionale Tumori of Milan are reported. Ninety-three were new cases, 40 were recurrences, and 28 were patients who underwent restaging diagnostic procedures without clinical evidence of disease. The majority of the cases were adenocarcinomas (146/161, or 91%), 10 were mixed adenosquamous carcinomas (6%) and 5 (3%) were adenoacanthomas. The overall incidence of pathologic lymphograms was 30% (46/161 patients). The incidence of the lymphatic spread was related to the clinical stage and to the extent of recurrent disease. In fact, in the 93 new cases, lymphography was positive in 11% of patients at stage I, 39% at stage II, 57% at stage III and 67% at stage IV disease. In the 40 pretreated patients, lymph node involvement was 33% in vaginal recurrences, 52% in pelvic abdominal recurrences and 73% in widespread diffusion. Finally, in 28 pretreated patients with no evidence of disease, the incidence of lymph node involvement was 7%. Metastases were found only in the pelvic nodes in 59% of the patients and only in the para-aortic nodes in 10%; in 31%, both chains were simultaneously involved; bilateral involvement was found in 45% of the patients with radiologically proven metastases. The 5-yr survival rate for patients at stage I-II and III disease with positive lymphography was 47.6% as compared with 83.5% for negative cases. In patients at stage I and II, the difference of survival was equal to 23.4%. The reliability of the results is confirmed by the concordance with the data of the literature on histologic involvement, by the first radiologic-anatomic comparison, and by the clinical course of the positive cases. Lymphography is of unquestionable value for an appropriate staging and for a correct treatment. The prognostic significance of the procedure is evident and such as to justify a major therapeutic aggressiveness in positive cases.

Present Status of Treatment for Invasive Cervical Carcinoma

The results are presented of a retrospective clinical study carried out on 341 patients affected with cancer of the uterine cervix, with lymphography in the pretreatment diagnostic work-up, treated in our Institute from January 1961 to December 1976. The clinical classification of the patients studied was: 157 cases in Stage I (46.0%), 95 cases in Stage II (27.9%), and 89 cases in Stages III and IV (26.1%). During the period considered, the therapeutic approach for carcinoma of the cervix was practically constant and in line with the therapeutic policy most frequently followed for these neoplasms. For the early stages (9/341 patients or 27.6%) preference was given to a radical surgery and postoperative radiotherapy combination; for borderline cases and « bulky » and « barrel-shaped » lesions, radiotherapy usually preceded surgical treatment to enlarge its indications and improve its results (36/341 patients or 10.5%). The cases that were more developed locally or that presented contraindications to surgery received radiological treatment alone (211/341 patients or 61.9%). Radiotherapy treatment consisted of radium therapy performed with a single application of 226Ra conventional sources, followed by percutaneous irradiation with 60Co-teletherapy in the more developed cases and/or in the presence of lymph node metastases. All the patients were submitted to diagnostic lymphography at the onset of the treatment and 92 (26.9%) had lymph node metastases. In the framework of this clinical review, the 5-year disease-free survival from onset of the treatment varied from 88.2% for the cases at Stage Ib occult, 72.5% for the cases at Stage Ib, 63.8% for the Stage II cases, to 40.5% for the cases at Stages III and IV. The presence of a pathologic report at lymphography makes a considerable difference in terms of disease-free, long-term survival after treatment.

Are retroperitoneal lymph node metastases a major problem in endometrial adenocarcinoma? Diagnostic and prognostic assessment with lymphography

The results of foot lymphography in 295 patients with endometrial carcinoma observed from 1968 to 1978 at two institutions are reported. One hundred and eighty-two were new cases, 61 were recurrences, and 52 were patients who underwent restaging diagnostic procedures without clinical evidence of disease. The incidence of lymphatic spread was correlated with the clinical stage, the pathologic stage, and the extent of recurrent disease. In fact, in the 182 new cases, at clinical stage, the pathologic stage, lymphography was positive in 8.9% of patients at Stage I, 28.6% at Stage II, 57.1% at Stage III, and 66.6% at Stage IV disease; at pathological stage, lymphography was positive in 8% of patients at Stage I, 14.8% at Stage II, 39.3% at Stage II, and 53.3% at Stage IV disease. There was lymph node involvement in 47.5% of the 61 pretreated patients. Finally, in 52 pretreated patients with no evidence of disease, the incidence of lymph node involvement was 7.7%. In new cases, metastases were found only in the pelvic nodes in 56.2% of the patients and only in the para-aortic nodes in 9.5%; in 34.3%, both chains were simultaneously involved. The five-year survival rate for patients at Stage I, II, and III disease with positive lymphography was 35% as compared with 73% for negative cases. In patients at Stage I and II, the difference of survival was equal to 24%. The reliability of the results is confirmed by the concordance with the data of the literature on histologic involvement, by the first radiologic-pathologic comparison, and by the clinical course of the positive cases. Lymphography is of unquestionable value for an appropriate staging and for a correct plan of treatment.