Prophylactic Para-Aortic Nodal Irradiation in Carcinoma Cervix: To Do or Not to Do?

The role of para-aortic lymph nodal irradiation (PALNI) remained undefined so far. Firstly, FIGO staging did not take nodal status into account hence the node positive patients remained an undefined subgroup. Secondly, despite RTOG trials establishing the survival advantage of prophylactic PALNI, it was not advocated due to the fear of adverse toxicity profile. The adoption of more conformal radiation techniques has revisited this issue. As with the recent advances in technology in imaging as well as the treatment techniques, there has been a tremendous improvement in treatment delivery leading to reduction in the incidence of acute as well as late toxicities. The interest in PALNI has also been triggered by the new FIGO staging which has defined and assigned a stage group to the pelvic and paraaortic LN positive cases. With this pretext in mind we review the current status of prophylactic paraaortic irradiation.