RECURRENT CARCINOMA OF THE CERVIX EXCLUSIVELY IN THE PARAAORTIC NODES FOLLOWING RADIATION-THERAPY

Purpose: This is a retrospective analysis of 1211 patients with invasive carcinoma of the uterine cervix treated with irradiation alone at the Mallinckrodt Institute of Radiology from 1959 through 1986, of whom 20 developed their first recurrence exclusively in the paraaortic lymph nodes. Methods and Materials: The incidence of clinically/radiographically detected paraaortic node recurrence by stage at original diagnosis was 1.8% in Stage IB (7/384 patients), 2.3% in Stage IIA (3/128 patients), 1.4% in Stage IIB (5/353 patients), 1.4% in Stage III (4/292 patients), and 5% in Stage IVA (1/20 patients). Forty-five percent of para-aortic node recurrences were observed within the first 12 months after initial diagnosis and 75% within the first 2 years. Sciatic pain, leg edema, and hydronephrosis were identified in most patients. Patients were treated with external irradiation only to the paraaortic lymph nodes. Results: All patients died within 2 years of paraaortic recurrence. Median survival for the entire group was 8.7 months. Median survival was 7.5 months for those failing within 24 months of the original diagnosis compared with 17.8 months for those failing after 24 months from original diagnosis (p = 0.09). Patients who received > 4500 cGy had a median survival of 14.2 months compared with 7.1 months for those treated with < 4500 cGy to the paraaortic recurrence (p = 0.004). Forty-five percent of patients developed mild to moderate nausea during paraaortic irradiation; however, no severe complications from the radiation therapy were noted. Conclusion: Sciatic pain, leg edema, and hydronephrosis commonly occur in patients with paraaortic node recurrence. The presence of these symptoms in a patient with a history of carcinoma of the cervix should initiate an aggressive evaluation.