(12) EXTRAPERITONEAL DISSECTION OF PARA-AORTIC AND COMMON ILIAC NODES COMBINED WITH 6000 .RADS

EXTENDED FIELD IRRADIATION FOR CARCINOMA OF THE CERVIX

Helmut F. Schellhas, M.D.+Bernard S. Aron, M.D.,** Foroogh K. Jazy, M.D.*,*and Alfonso E. Barnes, M.D. *

*Department of Obstetrics and Gynecology and **Department of Radiology, Division of Radiation Therapy, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267

Regional lymph node involvement in carcinoma of the cervix is of special interest to the radiation therapist. While the pelvic nodes receive cancero- tidal doses with combined whole pelvis irradiation and intracavitary radium therapy, the common iliac nodes frequently receive a smaller dose. The para- aortic nodes not included in conventional radiation therapy are often involved with tumor. Extended field radiation therapy to known positive para-aortic nodes has resulted in long term survivors but has also produced severe com- plications.

Extraperitoneal dissection of para-aoftic and comnon iliac nodes through an incision outside the fields of irradiation combined with 6000 rads extended field para-aortic node irradiation has been well tolerated by all patients treated.

The technique of extraperitoneal dissection of the aortic and common iliac nodes through an upper abdominal incision is described in detail and well illustrated. The procedure is devised to avoid gastrointestinal com- plications often found after transperitoneal evaluation of the para-aortic area followed by extended field irradiation. This delivers a total dose of 6000 rads in thirty treatments in six to seven weeks with a 4Mv linear accelerator. The upper border of the extended field is the Li-L2 interspace. Anterior and posterior fields were utilized to deliver 3000 - 4000 rads and 360 degree rotation therapy to deliver additional 2000 - 3000 rads.

Approximately 40 patients were explored and 10 patients were treated with 6000 rads extended field irradiation with a 3 to 24 month follow up.

(13) PARA-AORTIC LYMPHADENECTOMY IN GYNECOLOGIC MALIGNANCIES CONFINED TO THE PELVIS

Gregorio Delgado, M.D. and Byungku Chun, M.D.

Georgetown University Hospital Washington, D.C.

Of 64 patients with gynecologic malignancies apparently confined to the pelvis after extensive work-up and histologic examination of tissue biopsies outside the pelvis at the time of laparotomy, 19 (30%) had meta- static cancer in the para-aortic nodes. Twelve of 43 patients with cancer of the cervix, 5 of 13 uterine cancers and 3 of 8 with ovarian cancer had positive para-aortic nodes. The value of para-aortic node dissection in pelvic malignancies confined to the pelvis is discussed.

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