Lymph node control in cervical cancer

Purpose: The aim was to evaluate pretreatment lymph node size, irradiation dose, and failure patterns. Methods: Pretreatment PET and CT were performed in 208 patients. Lymph nodes were scored as either positive or negative by PET and lymph node size was measured by CT. Lymph node irradiation dose and sites of failure were recorded. Results: The mean pelvic lymph node doses were: PET negative nodes, less than or equal to1 cm, 66.8 Gy, and 0/76 failures; PET positive nodes, less than or equal to1 cm, 66.8 Gy, and 3/89 failures; 1.1-less than or equal to2 cm, 66.9 Gy, and 0/21 failures; 2.1-less than or equal to3 cm, 69.4 Gy, and 2/15 failures; and 3.1 to less than or equal to4 cm, 74.1 Gy, and 0/5 failures. The mean paraaortic lymph node dose was 43.3 Gy and there were no paraaortic failures for 24 patients with PET positive less than or equal to1 cm nodes, 0/5 failures for 1.1 to less than or equal to2 cm, and 0/4 failures for 2.1 to less than or equal to3 cm. The most common site of failure was distant metastases. Conclusions: The irradiation doses given in this study were adequate to control most lymph node metastases. Positive lymph nodes of any size at diagnosis were the most significant predictor for developing distant metastases. (C) 2004 Elsevier Inc.