Late effects of para-aortic irradiation in carcinoma of the uterine cervix and endometrium.

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Abstract
Twenty-one patients with cervical or endometrial carcinoma and metastases to the para-aortic lymph nodes were treated with extended-field para-aortic irradiation. The late effects of this treatment were evaluated in 16 patients who had a minimum follow-up of six months. All of the patients with massive pelvic tumours died of active disease in the pelvis with or without metastases. Three patients had small-bowel complications; none of the patients who underwent exploratory laparotomy for lymph node biospy had bowel complications. The results indicate that patients with central lesions and minimal para-aortic disease benefit most from para-aortic irradiation. It is concluded that metastases to the para-aortic lymoh nodes do not necessarily indicate more distant spread, and can be cured with irradiation. The late complication rate can be minimized by reducing the dosage to the small bowel with a combination of anterior-posterior fields and 360 degree rotation or opposing lateral 120 degree arc fields, and by using the extraperitoneal approach for lymph node biopsy.

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