Lymphatic metastasis is the main spreading method of cervical cancer .Cervical cancer lymphatic metastasis is divided into two groups: the level one group mainly includes paracervical lymph nodes, parauterine lymph nodes, obturator lymph nodes, internal iliac lymph nodes, external iliac lymph nodes, and presacral lymph nodes; level two groups mainly include common iliac lymph nodes, inguinal lymph nodes, and main arterial lymph nodes.Patients with definite inguinal lymph node metastasis and patients with invasion of the lower third of the vagina should receive inguinal region irradiation according to NCCN guidelines.Irradiation in the inguinal region may cause skin damage, even rupture, local contracture, edema of the lower extremities and necrosis of the femoral head, which may bring certain physical and mental harm to the patients.Radiotherapy is needed for patients with inguinal lymph node metastasis,but does cervical cancer patient with invaded lower third of the vagina without lymph node metastasis need preventive inguinal area irradiation?
At present, imaging examination methods are often used to assess the metastasis of lymph nodes. Common imaging examinations include computer tomography CT[8–9], magnetic resonance imaging MRI[10–11], positron emission tomography PET12, PET -CT [13–15], and ultrasound US for inguinal lymph node examination, but the accuracy is not high.Ultimately, ultrasound-guided fine needle aspiration (USgFNAC) is required for pathological examination [9,16,17].Stecklein et al. found that 33 (8%) of the 407 patients with stage III-IV vulvar cancer had inguinal lymph node enlargement through imaging examination, but only eight (2%) of the cases were actually tumor metastasis after biopsy.All the 33 patients underwent radiotherapy and chemotherapy. Three years later, there were 4 cases of lymph node recurrence in the inguinal region, including three cases of simultaneous vulvar region recurrence. Therefore, lymph node recurrence in the inguinal region may be related to vulvar region recurrence.Henriksen's study found that the inguinal lymph node metastasis rate of cervical cancer was 8%, but the clinical estimate was more than 25% wrong when compared with autopsy results, and the lymph nodes with inflammation and sclerosis were mistaken for malignant metastasis .In this study, 13 cases (7.07%) of 184 patients with cervical cancer were found to have inguinal lymph node enlargement, while only four cases (2.17%) were pathologically confirmed to have inguinal lymph node metastasis, indicating a significant difference between imaging and pathological diagnosis.Our study found that two of the four patients with inguinal lymph node metastasis were cervical cancer stage IV patients, with multiple metastases in the whole body including supraclavicular lymph nodes.Inguinal lymph node metastasis may be associated with strong invasion and metastasis ability of cancer cells and the late stage of the disease.At present, there is no clear evidence that cervical cancer patients with invasion of the lower third of the vagina are prone to inguinal lymph node metastasis, especially those confirmed by pathology.
We compared the local secondary injury and local recurrence rate of the groin in 180 patients with cervical cancer accompanied by the lower 1/3 vaginal invasion.We found that there was no recurrence in the inguinal lymph nodes in the non-preventive irradiation group, except for the local side damage less than the preventive irradiation group.Some studies have found that the rate of inguinal lymph node metastasis in patients with cervical cancer recurrence accounts for 9.8%. Even if the inguinal lymph node recurrence occurs, the prognosis after active treatment of enlarged lymph nodes is better .In the follow-up of cervical cancer patients after treatment by Fagundes et al. for 10 years, 199 cases of 312 patients with stage III ~ IVA developed recurrence and metastasis, among which 8 cases (4%) had inguinal lymph node metastasis. It can be seen that the rate of inguinal lymph node recurrence and metastasis after treatment of advanced cervical cancer is not high .