Modification of radiation therapy following operative evaluation of patients with cervical carcinoma

Twelve of thirty-nine patients with cervical cancer who underwent bilateral pelvic and periaortic lymphadenectomy through an extraperitoneal approach had lymph node metastases. Four patients had metastases to pelvic lymph nodes only and eight had metastases to common iliac or periaortic lymph nodes in addition to other pelvic lymph nodes. The operative findings permitted the modification of radiation therapy on the basis of known extent of tumor. All patients with common iliac or periaortic lymph node metastases had ports of external therapy extended to the level of the diaphragm and had more emphasis placed on external radiation therapy and less on intracavitary therapy. The sequence of operation through an extraperitoneal approach followed by conventional or extended radiation therapy was tolerated with minimal morbidity and no mortality.