What is False statement about treatment of Ca cervix:a) Radiotherapy is helpful in all stagesb) Prognosis of surgery good if done in early stagesc) When Radiotherapy is given, para aortic LN's should be includedd) Chemotherapy is reserved for late stagese) From stage Ib onwards same prognosis with surgery and RT and explain in detail?
I have discussed management of cancer cervix in detail in preceeding text.
Option “a”: Radiotherapy is helpful in all stages. ... Correct
Option “b”: Prognosis of surgery is good if done in early stages. ... Correct
Option “c”: When radiotherapy is given para aortic LN should be included. It is incorrect as routine radiotherapy for cancer cervix does not include para aortic lymphnodes. If para aortic lymph nodes are involved then only extended field radiotherapy should be given.
“The routine use of extended field radiation for prophylactic para aortic radiation without documentation of distant metastasis to para aortic nodes was evaluated and is not practiced because of increased enteric morbidity associated with this treatment modality.”
Note:
• IOC to know whether para-aortic lymph nodes are evolved is PET/CT imaging studies.
• Radiotherapy for para aortic lymph nodes leads to bowel complications and to avoid these complications, extra peritoneal dissection of para aortic nodes is recommended and the dose of radiation should be reduced to 5000 cGy or less. When this approach is used, post radiotherapy bowel complications occur in < 5% patients and 5 year survival rate is 15—26% in patients with positive para aortic nodes.
Option “d”: Chemotherapy is reserved for last stages. ... Correct
Option “e”: From stage 1B onwards same prognosis with surgery and RT.
The only data which I could get on this is –
“Stages 1B1,1B2 and 2A (size of lesion <4 cms)-these patients can be managed by surgery or primary chemoradiation.Several studies showed similar survival rates and outcomes.In bulky stages 1B2 and 2A2 -chemoradiation should be preferred but if patient wishes to conserve ovary then surgery should be done but it has increased morbidity because most of these patients have intermediate or high risk factors present for which post operative radiotherapy or chemoradiation has to be given.”