Introduction/Background Lymph node involvement in locally advanced cervical cancer impacts survival and defines radiation fields. False negatives (FN) of Fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) in the aortic region represent a limitation of this technique. It may lead to undertreatment of metastatic aortic lymph nodes. In selected cases, aortic lymph node staging can be considered to catch up the FN to tailor radiation fields. The aim was to analyze metastatic aortic lymph status according to FIGO 2009 classification and pelvic lymph node status.

Methodology From 01/2009 to 12/2019, we retrospectively reviewed all consecutive patients (pts) addressed for brachytherapy diagnosed with locally advanced cervical cancer FIGO 2009 stages IB2-IVa with negative PET-CT uptake in the aortic area and histologic lymph node involvement after surgical staging.

Results Of 178 pts who underwent surgical staging, metastatic aortic lymph nodes were found in 26 cases (FN rate=14,6%). Among these 26 pts, 12 (46%) did not show pelvic TEP-CT uptake, while 14 (54%) did. FIGO 2009 stages was IB2-II for 5 pts (19%), stage III for 20 pts (77%) and stage IV for 1 pt (4%). When analyzing pts with metastatic pelvic nodes, determined with preoperative PET-CT and FIGO 2009 staging system, aortic involvement was found in 4/5 pts (80%) of stages IB2-II and 10/20 pts (50%) of stages III.

Conclusion Aortic lymph node dissection is helpful to optimize radiation therapy fields in locally advanced cervical cancer. Pts with stages III and IV and those with stage Ib2-II and positive pelvic lymph seems to present the highest risk of occult aortic involvement. Aortic staging may be omitted in pts with stages Ib2-II without pelvic nodes as the risk of aortic involvement remains low.