Chasing nodes, saving lives? Lymph node metastases in cervical cancer

Accurately detecting lymph node metastases is crucial for determining the optimal treatment strategy for cervical cancer due to its prognostic impact. Therefore, the central question of this thesis is: "chasing nodes, saving lives?".
This thesis provides an overview of the literature on the detection of lymph node metastases in cervical cancer before treatment. Our research shows that PET-CT outperforms MRI and CT in detecting lymph node metastases in patients with early-stage cervical cancer, possibly due to the use of PET-CT as a verification modality. In patients with locally advanced cervical cancer and [18^F]FDG-positive lymph nodes, PET-CT guided the treatment strategy in 88% of cases, mainly consisting of nodal boosting (84%).
Presenting the lymph node status after radical surgery, by either the number of lymph node metastases or the lymph node ratio, offers additional prognostic value beyond the mere presence of lymph node metastases. For patients with early-stage cervical cancer and suspicious nodes on imaging, both primary chemoradiotherapy and radical surgery result in similar survival rates, although each strategy has different toxicity profiles.
For patients with advanced stages and bulky nodes (≥1.5 cm), shared decision-making and individualized treatment appear to be the best approach, as no survival difference was found between debulking or boosting. Regarding quality of life after treatment, women who underwent chemoradiotherapy generally reported worse outcomes than those with surgery, while lymphedema was more common after surgical treatment.
In conclusion, chasing nodes can save lives! However, improvements in the accuracy of nodal staging should continue in order to tailor treatment strategies and ultimately increase survival and health-related quality of life.