The value of pelvic venography and lymphography in the clinical staging of carcinoma of the uterine cervix. Analysis of 105 proven cases by surgery

Is prophylactic para-aortic irradiation worthwhile in the treatment of advanced cervical carcinoma? Results of a controlled clinical trial of the EORTC radiotherapy group

From November 1977 to July 1981, 441 patients with cervical carcinoma were randomized between pelvic irradiation and pelvic and para-aortic irradiation. Included were patients with stage I and IIB with proximal vaginal and/or parametrial involvement with positive pelvic lymph nodes either on lymphangiogram or at surgery, and stage IIB with distal vaginal and/or parametrial involvement and III regardless of pelvic node status on lymphangiogram. Patients with clinically or surgically involved para-aortic nodes were not included. The external beam dose to the para-aortic area was fixed at 45 Gy. There was no statistically significant difference between the two treatment arms in terms of local control, overall distant metastases and survival with no evidence of disease (NED), although the incidence of para-aortic metastases and distant metastases without tumor at pelvic sites was significantly higher in patients receiving pelvic irradiation alone (pelvic group). The 4-year NED survival rate was 51%. The incidence of severe digestive complications was significantly higher in patients receiving para-aortic irradiation (para-aortic group). Routine para-aortic irradiation for all high risk patients with cervical carcinoma is of limited value, but patients with a high probability of local control can benefit from extended field irradiation, despite an increase in severe digestive complications.

Value of lymphography in Stage IB cancer of the uterine cervix

In many neoplasms, lymphography is a reliable method with which lymph node metastases are demonstrated, but its accuracy in Stage IB cancer of the uterine cervix remains to be more firmly established. One hundred patients with Stage IB cancer of the uterine cervix underwent lymphography before radical hysterectomy with pelvic lymphadenectomy was contemplated. All the lymphographic findings were reviewed without knowledge of the pathologic parameters of the patients and were classified as being either positive (five cases), suspicious (15 cases), or negative (80 cases). The pathologic studies revealed lymph node metastases in 18 patients--in five with positive lymphographic findings, in three with suspicious findings, and in 10 with negative ones. The five true positive cases were compared to the 13 false negative or suspicious lymphographic results. It appears that the former have a greater number of involved lymph nodes and a greater mean size of the metastases. Thus, in Stage IB cancer of the uterine cervix, lymphography demonstrates an excellent specificity (100%) but a low sensitivity (27.8%).

Value of tumor-antigen (TA-4) of squamous cell carcinoma in predicting the extent of cervical cancer

The value of a tumor-antigen (TA-4) of squamous cell carcinoma in evaluating the extent of disease was studied in patients who primarily had surgical treatments with a diagnosis of cervical squamous cell carcinoma. Pretreatment serum TA-4 levels were determined by a radioimmunoassay method. The extent of disease was determined by surgical evaluation and postoperative histologic examinations. Furthermore, all patients were followed for at least two years, and those patients who developed recurrence at the sites which were unresectable by radical hysterectomy were retrospectively regarded as the unresectable case. It was found that serum TA-4 levels reflected the extent of disease, and that high pretreatment TA-4 levels indicated the presence of the widespread tumor which was unresectable by radical hysterectomy.

Excretory urography in evaluation of the surgical cancer patient

Excretory urography was performed routinely in 504 patients with sarcoma, melanoma, pelvic, head and neck, or other localized tumors over a 5-year period. There were benign abnormalities in 14.4% of the patients examined, tumor associated abnormalities in 10.7%, and 1.4% false positives. The diagnosis of a benign lesion did not change cancer therapy in any patient. Findings on excretory urography were valuable in the management of patients with pelvic and intra-abdominal tumors. In these patients ureteral obstruction was always caused by tumor. There was a high rate of false positively in non-abdominal tumors. No second primary tumors were found.

Lymphangiography in the determination of the extent of metastatic carcinoma: the potential value of percutaneous lymph node biopsy

In determining the extent of disease in patients with carcinoma, lymphangiography when read as positive has an accuracy of 90 to 95%. When considered negative 15 to 20% prove to have metastatic disease. the recent use of percutaneous transperitoneal aspiration biopsy of previously opacified lymph nodes has enhanced the value of lymphangiography. Eighty percent of the aspiration biopsies yield sufficient tissue for cytologic diagnosis.

Lymphography in carcinoma of the uterine cervix

Lymphography was carried out in a series of 158 patients with carcinoma of the uterine cervix. The diagnostic accuracy rate of 85 per cent compares favourably with the results of a similar investigation made ten years ago. Positive lymphography does not alter the survival rate in clinical stages I and II, probably due to the more accurate and selective therapeutic approach induced by lymphography. In stage III the 2-year survival rate of patients with negative findings is 58 per cent compared to only 17 per cent in case of positive lymphographic findings.