Brockbank, E., Kokka, F., Bryant, A., Pomel, C., Reynolds, K. (2013) Pre-treatment surgical para-aortic lymph node assessment in locally advanced cervical cancer. COCHRANE DATABASE OF SYSTEMATIC REVIEWS (3). ISSN 1469-493X

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Abstract

Background This is an updated version of the original Cochrane review published in The Cochrane Library, Issue 4, 2011. Cervical cancer is the most common cause of death from gynaecological cancers worldwide. Locally advanced cervical cancer, FIGO stage (International Federation of Gynaecology and Obstetrics) equal or more than IB1 is treated with chemotherapy and external beam radiotherapy followed by brachytherapy. If there is metastatic para-aortic nodal disease, radiotherapy is extended to cover this area. Due to increased morbidity, ideally extended-field radiotherapy is given only when para-aortic nodal disease is confirmed. Therefore, accurate assessment of the extent of the disease is very important for planning the most appropriate treatment. Objectives To evaluate the effectiveness and safety of pre-treatment surgical para-aortic lymph node assessment for woman with locally advanced cervical cancer (FIGO stage IB2 to IVA). Search methods We searched the Cochrane Gynaecological Cancer Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2012, Issue 10), MEDLINE and EMBASE (up to November 2012). We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. Selection criteria Randomised controlled trials (RCTs) that compared surgical para-aortic lymph node assessment and dissection with radiological staging techniques, in adult women diagnosed with locally advanced cervical cancer. Data collection and analysis Two review authors independently assessed whether potentially relevant trials met the inclusion criteria, abstracted data and assessed risk of bias. One RCT was identified so no meta-analyses were performed. Main results We found only one trial, which included 61 women, that met our inclusion criteria. This trial reported data on surgical versus clinical staging and an assessment of the two surgical staging techniques; laparoscopic (LAP) versus extraperitoneal (EXP) surgical staging. The clinical staging was either a contrast-enhanced computed tomography (CT) scan or magnetic resonance imaging (MRI) scan of the abdomen and pelvis to determine nodal status. In this trial, clinical staging appeared to significantly prolong overall and progression-free survival compared to surgical staging. There was no statistically significant difference in the number of women who experienced severe (grade 3 or 4) toxicity. There was no statistically significant difference in the risk of death, disease recurrence or progression, blood loss, severe toxicity and the duration of the operational procedure between LAP and EXP surgical staging techniques. The strength of the evidence is weak in this review as it is based on one small trial that was at moderate risk of bias. Authors' conclusions Since the last version of this review no new studies were found. From the one available RCT we found insufficient evidence that pre-treatment surgical para-aortic lymph node assessment for locally advanced cervical cancer is beneficial, and it may actually have an adverse effect on survival. However, this conclusion is based on analysis of a small single trial and therefore definitive guidance or recommendations for clinical practice cannot be made. Therefore, the decision to offer surgical pre-treatment assessment of para-aortic lymph nodes in locally advanced cervical cancer needs to be individualised. The uncertainty regarding any impact on survival from pre-treatment para-aortic lymph node assessment should be discussed openly with the women.

Item Type:	Review Article
All Authors:	Brockbank, E., Kokka, F., Bryant, A., Pomel, C., Reynolds, K.
Additional Information:	ISI Document Delivery No.: 116MR Times Cited: 0 Cited Reference Count: 57 Brockbank, Elly Kokka, Fani Bryant, Andrew Pomel, Christophe Reynolds, Karina Department of Gynaecological Oncology, St Bartholomew's Hospital, Barts; London NHS Trust, London, UK; Department of Health, UK; NHS Cochrane Collaboration programme Grant Scheme [CPG-506] Internal sourcesDepartment of Gynaecological Oncology, St Bartholomew's Hospital, Barts and The London NHS Trust, London, UK.External sourcesDepartment of Health, UK. NHS Cochrane Collaboration programme Grant Scheme CPG-506 Wiley-blackwell Hoboken
Uncontrolled Keywords:	Aorta, Abdominal Disease-Free Survival Lymph Node Excision [adverse effects] Lymph Nodes [pathology surgery] Lymphatic Metastasis Magnetic Resonance Imaging Neoplasm Staging [methods] Randomized Controlled Trials as Topic Tomography, X-Ray Computed Uterine Cervical Neoplasms [pathology radiotherapy surgery] Adult Aged Female Humans Middle Aged gynecologic-oncology-group extended-field irradiation stage-iib extraperitoneal approach preliminary experience radiation-therapy controlled-trials randomized-trial uterine cervix iva carcinoma
Research teams:	Clinical Units > Other Royal Marsden Services/Clinical Units
Depositing User:	Alexander Smithson
Date Deposited:	15 May 2013 16:53
Last Modified:	15 May 2013 16:53
URI:	http://publications.icr.ac.uk/id/eprint/12440

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