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Incidence of mesorectal node metastasis in locally advanced cervical cancer: its therapeutic implications
  1. Francisco Cordero-Gallardo1,
  2. O Lee Burnett III1,
  3. Michelle M McNamara2,
  4. Therese M Weber2,
  5. Jessica Zarzour2,
  6. Sejong Bae3,
  7. Samuel Jang4,
  8. Olivia Claire Barrett1,
  9. Andrew McDonald1 and
  10. Robert Y Kim1
  1. 1 Department of Radiation Oncology, University of Alabama Medical Center, Birmingham, Alberta, USA
  2. 2 Department of Diagnostic Radiology, University of Alabama Medical Center, Birmingham, Alabama, USA
  3. 3 Preventative Medicine, University of Alabama Medical Center, Birmingham, Alabama, USA
  4. 4 University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
  1. Correspondence to Robert Y Kim, Hazelrig Salter Radiation Oncology Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA; rkim{at}


Objective To evaluate the incidence and risk factors for mesorectal node metastasis (MRNM) in locally advanced cervical cancer.

Methods/Materials We performed an observational retrospective cohort study of 122 patients with cervical cancer who received definitive chemo-radiation treatment between December 2013 and June 2017 to evaluate the incidence of MRNM. Three diagnostic radiologists assessed all available pre-treatment images. In this study, the pelvic node metastasis was defined as ≥ 1.0 cm and MRNM as ≥ 0.5 cm for CT and MRI scans and as a maximum standardized uptake value of > 2.5 for PET/CT. The relationship of MRNM with FIGO stage, pelvic node metastasis, and mesorectal fascia involvement was evaluated.

Results The incidence of MRNM in all 122 patients was 8 (6.6%). However, in advanced stage (III– IV) patients, MRNM occurred in 4 of 39 (10.3%) compared with 4 of 83 (4.8%) in early stage (IB1–IIB) patients (p = 0.27). In patients with a positive pelvic node, MRNM occurred in 7 of 55 (12.7%) and 1 of 67 (1.5%) in those with negative pelvic node (p = 0.02). In addition, the incidence of MRNM was 3 of 9 (33.3%) in the presence of mesorectal fascia involvement and 5 of 113 (4.4%) among those without mesorectal fascia involvement (p = 0.013).

Conclusion This study indicates that pelvic node metastasis and mesorectal fascia involvement are high-risk factors for MRNM. Therefore, vigilance of reviewing images in the mesorectum for MRNM is necessary for high-risk patients.

  • locally advanced cervical cancer
  • incidence of mesorectal node metastasis
  • pelvic radiotherapy

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Ethics approval This study was approved by the Institutional Review Board at our institution.

  • Provenance and peer review Not commissioned, externally peer reviewed.