Impact of the Number of Positive Pelvic Lymph Nodes on Risk of Para-Aortic Recurrence in Patients with Clinically Early Cervical Cancer Treated by a Radical Hysterectomy and Pelvic Lymphadenectomy

Background: Guidelines recommend the extension of the pelvic radiotherapy volume to the para-aortic region in locally advanced cervical cancer and ≥3 suspicious pelvic lymph nodes (PLN) on imaging. Whether this recommendation is also valid for clinically early stages is uncertain. The objective of this study was to investigate the para-aortic (PAO) lymph node recurrence rate in patients with early-stage cervical cancer, ≥3 metastatic PLN, and negative common iliac nodes after a radical hysterectomy followed by pelvic (chemo)radiotherapy without extension to the PAO region. Methods: Consecutive patients, surgically treated between 2000 and 2020, with FIGO 2009 stage IB2-IIA1 and positive PLN, were included in this retrospective cohort study. The frequency of PAO recurrences, disease-free survival, and overall survival were analyzed in patients with <3 versus ≥3 positive PLN. Results: In 127 patients, the isolated PAO recurrence rate was 2/88 (2.3%) versus 1/39 (2.6%) for patients with <3 versus ≥3 positive PLNs, respectively (p = 0.671). The 5-year disease-free survival (87.3% versus 73.7%; p = 0.088) and the overall survival (90.7% versus 76.5%; p = 0.355) between patients with <3 versus ≥3 positive PLN was not significantly different. Conclusions: Isolated PAO nodal recurrence rate in women with early-stage cervical cancer after radical hysterectomy and pelvic lymphadenectomy, with positive PLN but negative common iliac nodes, followed by pelvic (chemo)radiotherapy, is low and did not differ between the groups with <3 versus ≥3 positive PLN. This makes it unlikely that the inclusion of the PAO region in the adjuvant radiotherapy volume would result in a better oncological outcome.