Gynecological Cancer

PV QA 4 - Poster Viewing Q&A 4

TU_15_3468 - Incidence of Mesorectal Node Metastasis in Locally Advanced Cervical Cancer: Its Therapeutic Implications

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

Incidence of Mesorectal Node Metastasis in Locally Advanced Cervical Cancer:  Its Therapeutic Implications
R. Y. Kim1, F. Cordero-Gallardo1, O. L. L. Burnett III1, M. McNamaro1, T. Weber1, J. Zarzour1, S. Bae1, S. Jang2, O. Barrett1, and A. M. McDonald1; 1University of Alabama at Birmingham, Birmingham, AL, 2University of Wisconsin School of Medicine and Public Health, Department of Human Oncology, Madison, WI

Purpose/Objective(s): Conventional 3-D conformal radiotherapy (3D-CRT)/IMRT for cervical cancer include the primary tumor and regional lymph node in the pelvis. However, the rectum and mesorectum is not routinely included and is avoided to limit treatment related toxicity. Advance in imaging studies has been able to detect more metastatic disease recently. Inclusion of the mesorectal lymph node in 3D-CRT/IMRT is controversial at this time. Most recent contour guidelines for GYN IMRT consortium and EMBRACE II Study recommended including the entire mesorectum in certain situation. However, the best of our knowledge there is no reported data evaluating incidence of MRNM as pretreatment imaging studies in localized advanced cervical cancer. This study is to report our incidence of MRNM in locally advanced cervical cancer.

Materials/Methods: One hundred twenty-two cervical cancer patients (FIGO stage I 36, II 47, III 31, IV 8) sequentially treated in our department were reviewed (December 2013 – June 2017). Cervical cancer was grouped into early stage (I, IIA) and advanced stage (IIB, III, IV). Three diagnostic radiologists retrospectively assessed all available pre-treatment imaging for positive nodal involvement in the pelvis including the mesorectum.Imaging studies were CT 47, MRI 5, PET/CT 34, CT and MRI 5, CT and PET/CT 16, MRI and PET/CT 11 and all three images 4. Pelvic nodal metastasis defined as ≥ 1 cm, MRNM as ≥ 0.5cm for CT and MRI, PET/CT as positive SUV max > 2.5. The relationship of MRNM incidence with FIG O Stage, pelvic node and mesorectal fascia involvement were evaluated

Results: Overall incidence of pelvic node metastasis was 55 of 122 (45.1%). However, incidence was higher in advanced stage 41 of 69 (59.4%) than in early stage disease, 14 of 53 (26.4%). Table 1 shows MRNM status based on stage, pelvic node and mesorectal fascia status. Overall incidence of MRNM was 6.56%. However, MRNM is much higher among positive node metastasis and mesorectal fascial involvement.

Conclusion: Positive pelvic node and mesorectal fascial involvement are high-risk for MRNM. Therefore, vigilance of reviewing images in the mesorectum for MRNM is important in high-risk patient. If MRNM is confirmed by an imaging study, one should include the mesorectum in the target volume. Furthermore, given the ability of the rectum to tolerate 45 GY and also often too small to detect MRNM by imaging studies, the clinician could consider the entire mesorectum within the target volume if one or more of these high-risk factors are present.
Table 1 MRNM Status based on Stage, Pelvic Node and Mesorectal Fascia Status
Total MRNM - MRNM + % MRNM+ Statistics
Cervical caner 122 114 8 6.6%
Stage
Early Stage 53 52 1 1.9% P=0.14
Advanced Stage 69 62 7 10.1%
Pelvic LN Status
negative 67 66 1 1.5% P=0.02
positive 55 48 7 12.7%
Mesorectal Fascia Status
negative 113 108 5 4.4% P=0.013
positive 9 6 3 33.3%

Author Disclosure: R.Y. Kim: None. F. Cordero-Gallardo: None. O.L. Burnett: President; Alabama Wilderness Medical Association (AWMA). M. McNamaro: None. J. Zarzour: None. S. Bae: None. S. Jang: None. A.M. McDonald: None.

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