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Patterns of spread in node-positive cervical cancer: the relationship between local control and distant metastases.
Cancer J Sci Am. 1996 Sep-Oct; 2(5):256-62.CJ

Abstract

PURPOSE

The presence of metastatic pelvic nodes in stage I and II cervical cancer predicts for pelvic and distant recurrence. Whether this malignancy is a systemic disease at onset or locoregionally advanced disease is unclear. To examine this issue, we reviewed cases of node-positive stage I and II cervical cancer to analyze the patterns of spread and the relationship between local control and distant metastasis.

MATERIALS AND METHODS

Between 1964 and 1993, 163 patients with FIGO stage I-II cervical cancer underwent exploratory laparotomy and bilateral pelvic lymph node dissection and were found to have metastatic pelvic nodes. Patients with positive para-aortic nodes were excluded. Of these patients, 108 underwent radical hysterectomy and postoperative pelvic irradiation, 35 underwent radical hysterectomy without postoperative pelvic irradiation, and 20 did not undergo radical hysterectomy and were treated with definitive radiation therapy.

RESULTS

The overall 5- and 10-year actuarial disease-free survival rates for the entire group were 55% and 49%, respectively. The 5- and 10-year actuarial pelvic failure rates were 30.5% and 37%, respectively. The actuarial distant metastatic rates at 5 and 10 years were 30% and 34%, respectively. Patients who were controlled in the pelvis (114) had significantly lower rates of developing distant metastases at 5 and 10 years (21% and 22%, respectively) compared with patients who failed in the pelvis (49) with rates of 59% and 84%, respectively. Multivariate analysis found that pelvic failure had the strongest association with the development of distant metastases. Using the formula of Suit et al to assess potential improvement in cure from perfect local and distant control, survival advantages from increased local and distant control were 24% and 21%, respectively. Of those patients who failed both locally and distantly (22), 27% failed distantly 6 months or more after failing locally.

CONCLUSIONS

Early-stage node-positive cervical cancer is associated with both increased distant and local failure. There appear to be two patterns of disease spread: patients whose disease is locoregional, in whom improvements in local control can result in improved cure, and patients with biologically aggressive cancer, who probably have disseminated disease at presentation, in whom improved locoregional control will not be enough to increase survival but who require improved distant control.

Authors+Show Affiliations

Department of Radiation Oncology, Mount Sinai School of Medicine, New York, New York 10029, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

9166542

Citation

Stock, R G., et al. "Patterns of Spread in Node-positive Cervical Cancer: the Relationship Between Local Control and Distant Metastases." The Cancer Journal From Scientific American, vol. 2, no. 5, 1996, pp. 256-62.
Stock RG, Chen AS, Karasek K. Patterns of spread in node-positive cervical cancer: the relationship between local control and distant metastases. Cancer J Sci Am. 1996;2(5):256-62.
Stock, R. G., Chen, A. S., & Karasek, K. (1996). Patterns of spread in node-positive cervical cancer: the relationship between local control and distant metastases. The Cancer Journal From Scientific American, 2(5), 256-62.
Stock RG, Chen AS, Karasek K. Patterns of Spread in Node-positive Cervical Cancer: the Relationship Between Local Control and Distant Metastases. Cancer J Sci Am. 1996 Sep-Oct;2(5):256-62. PubMed PMID: 9166542.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Patterns of spread in node-positive cervical cancer: the relationship between local control and distant metastases. AU - Stock,R G, AU - Chen,A S, AU - Karasek,K, PY - 1996/10/1/pubmed PY - 2006/10/25/medline PY - 1996/10/1/entrez SP - 256 EP - 62 JF - The cancer journal from Scientific American JO - Cancer J Sci Am VL - 2 IS - 5 N2 - PURPOSE: The presence of metastatic pelvic nodes in stage I and II cervical cancer predicts for pelvic and distant recurrence. Whether this malignancy is a systemic disease at onset or locoregionally advanced disease is unclear. To examine this issue, we reviewed cases of node-positive stage I and II cervical cancer to analyze the patterns of spread and the relationship between local control and distant metastasis. MATERIALS AND METHODS: Between 1964 and 1993, 163 patients with FIGO stage I-II cervical cancer underwent exploratory laparotomy and bilateral pelvic lymph node dissection and were found to have metastatic pelvic nodes. Patients with positive para-aortic nodes were excluded. Of these patients, 108 underwent radical hysterectomy and postoperative pelvic irradiation, 35 underwent radical hysterectomy without postoperative pelvic irradiation, and 20 did not undergo radical hysterectomy and were treated with definitive radiation therapy. RESULTS: The overall 5- and 10-year actuarial disease-free survival rates for the entire group were 55% and 49%, respectively. The 5- and 10-year actuarial pelvic failure rates were 30.5% and 37%, respectively. The actuarial distant metastatic rates at 5 and 10 years were 30% and 34%, respectively. Patients who were controlled in the pelvis (114) had significantly lower rates of developing distant metastases at 5 and 10 years (21% and 22%, respectively) compared with patients who failed in the pelvis (49) with rates of 59% and 84%, respectively. Multivariate analysis found that pelvic failure had the strongest association with the development of distant metastases. Using the formula of Suit et al to assess potential improvement in cure from perfect local and distant control, survival advantages from increased local and distant control were 24% and 21%, respectively. Of those patients who failed both locally and distantly (22), 27% failed distantly 6 months or more after failing locally. CONCLUSIONS: Early-stage node-positive cervical cancer is associated with both increased distant and local failure. There appear to be two patterns of disease spread: patients whose disease is locoregional, in whom improvements in local control can result in improved cure, and patients with biologically aggressive cancer, who probably have disseminated disease at presentation, in whom improved locoregional control will not be enough to increase survival but who require improved distant control. SN - 1081-4442 UR - https://www.unboundmedicine.com/medline/citation/9166542/Patterns_of_spread_in_node_positive_cervical_cancer:_the_relationship_between_local_control_and_distant_metastases_ L2 - http://www.diseaseinfosearch.org/result/7949 DB - PRIME DP - Unbound Medicine ER -