ArticleInternational journal of radiation oncology, biology, physics2013
Anatomic distribution of fluorodeoxyglucose-avid para-aortic lymph nodes in patients with cervical cancer.
Article in International journal of radiation oncology, biology, physics, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
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Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it, 37 citations in OpenAlex.
- EANM/SNMMI practice guideline for [European journal of nuclear medicine and molecular imaging · 2021Guideline
- Spectral computed tomography in the assessment of metastatic lymph nodes in cervical cancer patients treated with definitive radiotherapy: a single-center, prospective study.Clinical & experimental metastasis · 2025Article
- Controversies in the Staging of Patients with Locally Advanced Cervical Cancer.Diagnostics (Basel, Switzerland) · 2023Review
- Recommendations of the clinical target volume for the para-aortic region based on the patterns of lymph node metastasis in patients with biliary tract cancer.Frontiers in oncology · 2022Article
- A modified delineation method of para-aortic nodal clinical target volume in patients with locally advanced cervical cancer.Cancer medicine · 2022Article
- Mapping patterns of para-aortic lymph node recurrence in cervical cancer: a retrospective cohort analysis.Radiation oncology (London, England) · 2021Article
- NRG Oncology/RTOG Consensus Guidelines for Delineation of Clinical Target Volume for Intensity Modulated Pelvic Radiation Therapy in Postoperative Treatment of Endometrial and Cervical Cancer: An Update.International journal of radiation oncology, biology, physics · 2021Article
- Distribution patterns of lymph node metastasis in early stage invasive cervical cancer.Medicine · 2020Article
- Pattern and risk factors of local recurrence after nephroureterectomy for upper tract urothelial carcinoma.World journal of surgical oncology · 2020Article
- Article
- Prophylactic Extended-Field Irradiation in Patients With Cervical Cancer: A Literature Review.Frontiers in oncology · 2020Review
- Reduction of dose to duodenum with a refined delineation method of Para-aortic region in patients with locally advanced cervical Cancer receiving prophylactic extended-field radiotherapy.Radiation oncology (London, England) · 2019Article
- Article
- Mapping patterns of nodal metastases in esophageal carcinoma: rethinking the clinical target volume for supraclavicular nodal irradiation.Journal of thoracic disease · 2016Article
- Contouring Guidelines for the Axillary Lymph Nodes for the Delivery of Radiation Therapy in Breast Cancer: Evaluation of the RTOG Breast Cancer Atlas.International journal of radiation oncology, biology, physics · 2015Article
- Clinical Outcomes and Prognostic Factors in Stage III C Cervical Cancer Patients Treated with Radical Radiotherapy or Radiochemotherapy.Technology in cancer research & treatmentArticle
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Authors and funding
10 authors at 1 institution in 1 country.
Funding
Abstract
purposeConformal treatment of para-aortic lymph nodes (PAN) in cervical cancer allows dose escalation and reduces normal tissue toxicity. Currently, data documenting the precise location of involved PAN are lacking. We define the spatial distribution of this high-risk nodal volume by analyzing fluorodeoxyglucose (FDG)-avid lymph nodes (LNs) on positron emission tomography/computed tomography (PET/CT) scans in patients with cervical cancer. METHODS AND MATERIALS: We identified 72 PANs on pretreatment PET/CT of 30 patients with newly diagnosed stage IB-IVA cervical cancer treated with definitive chemoradiation. LNs were classified as left-lateral para-aortic (LPA), aortocaval (AC), or right paracaval (RPC). Distances from the LN center to the closest vessel and adjacent vertebral body were calculated. Using deformable image registration, nodes were mapped to a template computed tomogram to provide a visual impression of nodal frequencies and anatomic distribution.
resultsWe identified 72 PET-positive para-aortic lymph nodes (37 LPA, 32 AC, 3 RPC). All RPC lymph nodes were in the inferior third of the para-aortic region. The mean distance from aorta for all lymph nodes was 8.3 mm (range, 3-17 mm), and from the inferior vena cava was 5.6 mm (range, 2-10 mm). Of the 72 lymph nodes, 60% were in the inferior third, 36% were in the middle third, and 4% were in the upper third of the para-aortic region. In all, 29 of 30 patients also had FDG-avid pelvic lymph nodes.
conclusionsA total of 96% of PET positive nodes were adjacent to the aorta; PET positive nodes to the right of the IVC were rare and were all located distally, within 3 cm of the aortic bifurcation. Our findings suggest that circumferential margins around the vessels do not accurately define the nodal region at risk. Instead, the anatomical extent of the nodal basin should be contoured on each axial image to provide optimal coverage of the para-aortic nodal compartment.
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