What indications do you use to prophylactically treat para-aortic lymph nodes in cervical cancer?

The answer to this question is not simple although there are some general rules that we use. First, I should mention that for patients with locoregionally advanced disease, we now usually treat to the bifurcation of the aorta as a minimum. This generally puts the upper border close to L3/L4. We began doing this several years ago because we were seeing too many recurrences just above the field, even in patients who had negative common iliac nodes. For patients who have small, N- tumors, we still ...

Our philosophy is based on PET/CT findings in patients who have had no surgical staging.

If the PET/CT is negative for any nodes, then we treat up to the common iliac nodes (the likelihood of a false negative PET for PA nodes in this setting is less than 10 percent).

If the PET/CT is positive for pelvic nodes only, then in this setting we tend to treat the PA region up to the renal vessels, as the false negative PET for PA nodes in this setting is 20 to 25 percent. What this means is that if you...