Para‐Aortic Node Irradiation in Carcinomas

The authors have retrospectively analyzed the results of para‐aortic node irradiation in 75 cases of metastatic carcinoma treated at the Department of Radiation Therapy, Roswell Park Memorial Institute, between 1963 and 1972. This group includes 62 patients with primary squamous cell carcinoma of the uterine cervix, 6 with adenocarcinomas of the sigmoid colon, 2 with adenocarcinomas of the endometrium, 3 with carcinomas of the vulva, 1 with adenocarcinoma of the ovary, and 1 with squamous cell carcinoma of the anus. The clinicopathologic behavior of para‐aortic metastasis is studied in detail, including the relationship with the primary site, histologic grade, and degree of lymphatic invasion at the primary site. The group of cervical cancer patients seems to consist predominantly of those with advanced clinical stage, less differentiated tumors, endophytic or endocervical lesions, and those with endometrial or myometrial involvement. This study showed that the presence of metastatic carcinomas in the para‐aortic nodes does not necessarily indicate the existence of more distant metastasis. These carcinomas can be safely irradiated and cured in a significant percentage of cases. Survival appears more favorable with higher radiation dosages. Six thousand rads delivered in 8 weeks, alone or concomitantly with pelvic irradiation, can be safely applied with minimal acute normal tissue reaction, and can eradicate the para‐aortic node metastasis.