Anatomic distribution and clinical target volume margin of para‐aortic lymph node metastasis in cervical cancer
Cheng Shuxia1, Wang Junyi2, Zhang Mingchuan1, Chen Huimin1, Ma Yiming1, Wu Hao1, Zhang Fuquan3
1Department of Gynecologic Oncology, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450003, China; 2Department of Clinical Medicine, Medical School of Zhengzhou University, Zhengzhou 450001, China; 3Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China
Abstract：Objective To determine the regional boundary of para‐aortic lymph node (PAN) metastasis in cervical cancer, and to explore the clinical target volume (CTV) margin. Methods Eight‐six patients with cervical cancer metastasis to PAN below and above left renal vein (LRV) were retrospectively included in this study. The anatomical relationship of the metastatic PANs and surrounding structures were analyzed according tocontrast‐enhanced computed tomography (CT) and three dimensional reconstruction images. Results Eight‐six patients had metastatic PANs belowLRV: metastatic nodes were located onthe medial side of ovarian vessels and ureters, behind the renal veins, duodenum, mesenteric vessels, in front of the anterior border of lumbar vertebra and psoas. The inferior mesenteric vein was close to the left anterior side of PANs. Where the duodenum appeared, no node was presenton the anterolateral side of the inferior vena cava (IVC).Above the LRV, 27 patients had retrocrural node involvement along the azygos and hemiazgos vein, and 25/27 cases were located below the junction level of cardia and oesophagus, and 5/27 patients had metastatic lymph nodes between IVC and the right crura of diaphragm, all below the level of coeliac trunk artery. Conclusions CTV margin delineation of PAN below and above LRV is recommended:superiorly, the junction level of cardia and oesophagus; laterally, crura and the medial side of ovarian vessels and ureters and inferior mesenteric vein; anteriorly, the posterior side of the coeliac trunk artery and renal veins and duodenum, mesenteric vessels; posteriorly, the anterior border of lumbar vertebra and psoas.
Cheng Shuxia,Wang Junyi,Zhang Mingchuan et al. Anatomic distribution and clinical target volume margin of para‐aortic lymph node metastasis in cervical cancer[J]. Chinese Journal of Radiation Oncology, 2022, 31(12): 1121-1126.
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