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Ferro M, Macchia G, Pezzulla D, Cilla S, Romano C, Ferro M, Boccardi M, Bonome P, Picardi V, Buwenge M, Morganti AG, Deodato F. Pattern of recurrence after stereotactic body radiotherapy of nodal lesions: a single-institution analysis. Br J Radiol 2024; 97:1295-1301. [PMID: 38741392 PMCID: PMC11186556 DOI: 10.1093/bjr/tqae099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 04/17/2024] [Accepted: 05/08/2024] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVES Stereotactic body radiotherapy (SBRT) and/or single fraction stereotactic body radiosurgery (SRS) are effective treatment options for the treatment of oligometastatic disease of lymph nodes. Despite the encouraging local control rate, progression-free survival remains unfair due to relapses that might occur in the same district or at other sites. The recurrence pattern analysis after nodal local ablative RT (laRT) in oligometastatic patients is presented in this study. METHODS The pattern of failure of patients with nodal metastases who were recruited and treated with SBRT in the Destroy-1 or SRS in the Destroy-2 trials was investigated in this single-institution, retrospective analysis. The different relapsed sites following laRT were recorded. RESULTS Data on 190 patients who received SBRT or SRS on 269 nodal lesions were reviewed. A relapse rate of 57.2% (154 out of 269 nodal lesions) was registered. The pattern of failure was distant in 88 (57.4%) and loco-regional in 66 (42.6%) patients, respectively. The most frequent primary malignancies among patients experiencing loco-regional failure were genitourinary and gynaecological cancers. Furthermore, the predominant site of loco-regional relapse (62%) was the pelvic area. Only 26% of locoregional relapses occurred contra laterally, with 74% occurring ipsilaterally. CONCLUSIONS The recurrence rates after laRT for nodal disease were more frequent in distant regions compared to locoregional sites. The most common scenarios for locoregional relapse appear to be genitourinary cancer and the pelvic site. In addition, recurrences often occur in the same nodal station or in a nodal station contiguous to the irradiated nodal site. ADVANCES IN KNOWLEDGE Local ablative radiotherapy is an effective treatment in managing nodal oligometastasis. Despite the high local control rate, the progression free survival remains dismal with recurrences that can occur both loco-regionally or at distance. To understand the pattern of failure could aid the physicians to choose the best treatment strategy. This is the first study that reports the recurrence pattern of a significant number of nodal lesions treated with laRT.
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Affiliation(s)
- Milena Ferro
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso 86100, Italy
| | - Gabriella Macchia
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso 86100, Italy
| | - Donato Pezzulla
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso 86100, Italy
| | - Savino Cilla
- Medical Physics Unit, Responsible Research Hospital, Campobasso 86100, Italy
| | - Carmela Romano
- Medical Physics Unit, Responsible Research Hospital, Campobasso 86100, Italy
| | - Marica Ferro
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso 86100, Italy
| | - Mariangela Boccardi
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso 86100, Italy
| | - Paolo Bonome
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso 86100, Italy
| | - Vincenzo Picardi
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso 86100, Italy
| | - Milly Buwenge
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
| | - Alessio G Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
- Department of Experimental, Diagnostic, and Specialty Medicine—DIMES, Alma Mater Studiorum, Bologna University, Bologna 40138, Italy
| | - Francesco Deodato
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso 86100, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome 00168, Italy
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Negm AS, Collins JD, Bendel EC, Takahashi E, Knavel Koepsel EM, Gehling KJ, Burke CE, Barker DR, Stenzel WS, Bathke AM, Polites SF, Abcejo AS, Morris JM, Favazza C, Lu A, François CJ, Young P, Thompson SM. MR Lymphangiography in Lymphatic Disorders: Clinical Applications, Institutional Experience, and Practice Development. Radiographics 2024; 44:e230075. [PMID: 38271257 DOI: 10.1148/rg.230075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Lymphatic flow and anatomy can be challenging to study, owing to variable lymphatic anatomy in patients with diverse primary or secondary lymphatic pathologic conditions and the fact that lymphatic imaging is rarely performed in healthy individuals. The primary components of the lymphatic system outside the head and neck are the peripheral, retroperitoneal, mesenteric, hepatic, and pulmonary lymphatic systems and the thoracic duct. Multiple techniques have been developed for imaging components of the lymphatic system over the past century, with trade-offs in spatial, temporal, and contrast resolution; invasiveness; exposure to ionizing radiation; and the ability to obtain information on dynamic lymphatic flow. More recently, dynamic contrast-enhanced (DCE) MR lymphangiography (MRL) has emerged as a valuable tool for imaging both lymphatic flow and anatomy in a variety of congenital and acquired primary or secondary lymphatic disorders. The authors provide a brief overview of lymphatic physiology, anatomy, and imaging techniques. Next, an overview of DCE MRL and the development of an MRL practice and workflow in a hybrid interventional MRI suite incorporating cart-based in-room US is provided, with an emphasis on multidisciplinary collaboration. The spectrum of congenital and acquired lymphatic disorders encountered early in an MRL practice is provided, with emphasis on the diversity of imaging findings and how DCE MRL can aid in diagnosis and treatment of these patients. Methods such as DCE MRL for assessing the hepatic and mesenteric lymphatic systems and emerging technologies that may further expand DCE MRL use such as three-dimensional printing are introduced. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Ahmed S Negm
- From the Department of Radiology, Division of Cardiovascular Imaging (A.S.N., J.D.C., E.T., D.R.B., W.S.S., C.F., A.L., C.J.F., P.Y., S.M.T.), Department of Radiology, Division of Vascular and Interventional Radiology (E.C.B., E.T., K.J.G., C.E.B., A.M.B., J.M.M., S.M.T.), Department of Surgery, Division of Pediatric Surgery (S.F.P.), and Department of Anesthesiology (A.S.A.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Section of Interventional Radiology, University of Wisconsin, Madison, Wis (E.M.K.K.)
| | - Jeremy D Collins
- From the Department of Radiology, Division of Cardiovascular Imaging (A.S.N., J.D.C., E.T., D.R.B., W.S.S., C.F., A.L., C.J.F., P.Y., S.M.T.), Department of Radiology, Division of Vascular and Interventional Radiology (E.C.B., E.T., K.J.G., C.E.B., A.M.B., J.M.M., S.M.T.), Department of Surgery, Division of Pediatric Surgery (S.F.P.), and Department of Anesthesiology (A.S.A.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Section of Interventional Radiology, University of Wisconsin, Madison, Wis (E.M.K.K.)
| | - Emily C Bendel
- From the Department of Radiology, Division of Cardiovascular Imaging (A.S.N., J.D.C., E.T., D.R.B., W.S.S., C.F., A.L., C.J.F., P.Y., S.M.T.), Department of Radiology, Division of Vascular and Interventional Radiology (E.C.B., E.T., K.J.G., C.E.B., A.M.B., J.M.M., S.M.T.), Department of Surgery, Division of Pediatric Surgery (S.F.P.), and Department of Anesthesiology (A.S.A.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Section of Interventional Radiology, University of Wisconsin, Madison, Wis (E.M.K.K.)
| | - Edwin Takahashi
- From the Department of Radiology, Division of Cardiovascular Imaging (A.S.N., J.D.C., E.T., D.R.B., W.S.S., C.F., A.L., C.J.F., P.Y., S.M.T.), Department of Radiology, Division of Vascular and Interventional Radiology (E.C.B., E.T., K.J.G., C.E.B., A.M.B., J.M.M., S.M.T.), Department of Surgery, Division of Pediatric Surgery (S.F.P.), and Department of Anesthesiology (A.S.A.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Section of Interventional Radiology, University of Wisconsin, Madison, Wis (E.M.K.K.)
| | - Erica M Knavel Koepsel
- From the Department of Radiology, Division of Cardiovascular Imaging (A.S.N., J.D.C., E.T., D.R.B., W.S.S., C.F., A.L., C.J.F., P.Y., S.M.T.), Department of Radiology, Division of Vascular and Interventional Radiology (E.C.B., E.T., K.J.G., C.E.B., A.M.B., J.M.M., S.M.T.), Department of Surgery, Division of Pediatric Surgery (S.F.P.), and Department of Anesthesiology (A.S.A.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Section of Interventional Radiology, University of Wisconsin, Madison, Wis (E.M.K.K.)
| | - Kathleen J Gehling
- From the Department of Radiology, Division of Cardiovascular Imaging (A.S.N., J.D.C., E.T., D.R.B., W.S.S., C.F., A.L., C.J.F., P.Y., S.M.T.), Department of Radiology, Division of Vascular and Interventional Radiology (E.C.B., E.T., K.J.G., C.E.B., A.M.B., J.M.M., S.M.T.), Department of Surgery, Division of Pediatric Surgery (S.F.P.), and Department of Anesthesiology (A.S.A.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Section of Interventional Radiology, University of Wisconsin, Madison, Wis (E.M.K.K.)
| | - Courtney E Burke
- From the Department of Radiology, Division of Cardiovascular Imaging (A.S.N., J.D.C., E.T., D.R.B., W.S.S., C.F., A.L., C.J.F., P.Y., S.M.T.), Department of Radiology, Division of Vascular and Interventional Radiology (E.C.B., E.T., K.J.G., C.E.B., A.M.B., J.M.M., S.M.T.), Department of Surgery, Division of Pediatric Surgery (S.F.P.), and Department of Anesthesiology (A.S.A.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Section of Interventional Radiology, University of Wisconsin, Madison, Wis (E.M.K.K.)
| | - Devin R Barker
- From the Department of Radiology, Division of Cardiovascular Imaging (A.S.N., J.D.C., E.T., D.R.B., W.S.S., C.F., A.L., C.J.F., P.Y., S.M.T.), Department of Radiology, Division of Vascular and Interventional Radiology (E.C.B., E.T., K.J.G., C.E.B., A.M.B., J.M.M., S.M.T.), Department of Surgery, Division of Pediatric Surgery (S.F.P.), and Department of Anesthesiology (A.S.A.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Section of Interventional Radiology, University of Wisconsin, Madison, Wis (E.M.K.K.)
| | - Wayne S Stenzel
- From the Department of Radiology, Division of Cardiovascular Imaging (A.S.N., J.D.C., E.T., D.R.B., W.S.S., C.F., A.L., C.J.F., P.Y., S.M.T.), Department of Radiology, Division of Vascular and Interventional Radiology (E.C.B., E.T., K.J.G., C.E.B., A.M.B., J.M.M., S.M.T.), Department of Surgery, Division of Pediatric Surgery (S.F.P.), and Department of Anesthesiology (A.S.A.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Section of Interventional Radiology, University of Wisconsin, Madison, Wis (E.M.K.K.)
| | - Angela M Bathke
- From the Department of Radiology, Division of Cardiovascular Imaging (A.S.N., J.D.C., E.T., D.R.B., W.S.S., C.F., A.L., C.J.F., P.Y., S.M.T.), Department of Radiology, Division of Vascular and Interventional Radiology (E.C.B., E.T., K.J.G., C.E.B., A.M.B., J.M.M., S.M.T.), Department of Surgery, Division of Pediatric Surgery (S.F.P.), and Department of Anesthesiology (A.S.A.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Section of Interventional Radiology, University of Wisconsin, Madison, Wis (E.M.K.K.)
| | - Stephanie F Polites
- From the Department of Radiology, Division of Cardiovascular Imaging (A.S.N., J.D.C., E.T., D.R.B., W.S.S., C.F., A.L., C.J.F., P.Y., S.M.T.), Department of Radiology, Division of Vascular and Interventional Radiology (E.C.B., E.T., K.J.G., C.E.B., A.M.B., J.M.M., S.M.T.), Department of Surgery, Division of Pediatric Surgery (S.F.P.), and Department of Anesthesiology (A.S.A.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Section of Interventional Radiology, University of Wisconsin, Madison, Wis (E.M.K.K.)
| | - Arnoley S Abcejo
- From the Department of Radiology, Division of Cardiovascular Imaging (A.S.N., J.D.C., E.T., D.R.B., W.S.S., C.F., A.L., C.J.F., P.Y., S.M.T.), Department of Radiology, Division of Vascular and Interventional Radiology (E.C.B., E.T., K.J.G., C.E.B., A.M.B., J.M.M., S.M.T.), Department of Surgery, Division of Pediatric Surgery (S.F.P.), and Department of Anesthesiology (A.S.A.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Section of Interventional Radiology, University of Wisconsin, Madison, Wis (E.M.K.K.)
| | - Jonathan M Morris
- From the Department of Radiology, Division of Cardiovascular Imaging (A.S.N., J.D.C., E.T., D.R.B., W.S.S., C.F., A.L., C.J.F., P.Y., S.M.T.), Department of Radiology, Division of Vascular and Interventional Radiology (E.C.B., E.T., K.J.G., C.E.B., A.M.B., J.M.M., S.M.T.), Department of Surgery, Division of Pediatric Surgery (S.F.P.), and Department of Anesthesiology (A.S.A.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Section of Interventional Radiology, University of Wisconsin, Madison, Wis (E.M.K.K.)
| | - Christopher Favazza
- From the Department of Radiology, Division of Cardiovascular Imaging (A.S.N., J.D.C., E.T., D.R.B., W.S.S., C.F., A.L., C.J.F., P.Y., S.M.T.), Department of Radiology, Division of Vascular and Interventional Radiology (E.C.B., E.T., K.J.G., C.E.B., A.M.B., J.M.M., S.M.T.), Department of Surgery, Division of Pediatric Surgery (S.F.P.), and Department of Anesthesiology (A.S.A.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Section of Interventional Radiology, University of Wisconsin, Madison, Wis (E.M.K.K.)
| | - Aiming Lu
- From the Department of Radiology, Division of Cardiovascular Imaging (A.S.N., J.D.C., E.T., D.R.B., W.S.S., C.F., A.L., C.J.F., P.Y., S.M.T.), Department of Radiology, Division of Vascular and Interventional Radiology (E.C.B., E.T., K.J.G., C.E.B., A.M.B., J.M.M., S.M.T.), Department of Surgery, Division of Pediatric Surgery (S.F.P.), and Department of Anesthesiology (A.S.A.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Section of Interventional Radiology, University of Wisconsin, Madison, Wis (E.M.K.K.)
| | - Christopher J François
- From the Department of Radiology, Division of Cardiovascular Imaging (A.S.N., J.D.C., E.T., D.R.B., W.S.S., C.F., A.L., C.J.F., P.Y., S.M.T.), Department of Radiology, Division of Vascular and Interventional Radiology (E.C.B., E.T., K.J.G., C.E.B., A.M.B., J.M.M., S.M.T.), Department of Surgery, Division of Pediatric Surgery (S.F.P.), and Department of Anesthesiology (A.S.A.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Section of Interventional Radiology, University of Wisconsin, Madison, Wis (E.M.K.K.)
| | - Phillip Young
- From the Department of Radiology, Division of Cardiovascular Imaging (A.S.N., J.D.C., E.T., D.R.B., W.S.S., C.F., A.L., C.J.F., P.Y., S.M.T.), Department of Radiology, Division of Vascular and Interventional Radiology (E.C.B., E.T., K.J.G., C.E.B., A.M.B., J.M.M., S.M.T.), Department of Surgery, Division of Pediatric Surgery (S.F.P.), and Department of Anesthesiology (A.S.A.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Section of Interventional Radiology, University of Wisconsin, Madison, Wis (E.M.K.K.)
| | - Scott M Thompson
- From the Department of Radiology, Division of Cardiovascular Imaging (A.S.N., J.D.C., E.T., D.R.B., W.S.S., C.F., A.L., C.J.F., P.Y., S.M.T.), Department of Radiology, Division of Vascular and Interventional Radiology (E.C.B., E.T., K.J.G., C.E.B., A.M.B., J.M.M., S.M.T.), Department of Surgery, Division of Pediatric Surgery (S.F.P.), and Department of Anesthesiology (A.S.A.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Section of Interventional Radiology, University of Wisconsin, Madison, Wis (E.M.K.K.)
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Chen J, Wang TY, Wu CC, Hsiao YC, Chang CL. Inguinal nodal metastatic squamous cell carcinoma of unknown primary (CUP) detected 7 years before the diagnosis of vulvar squamous cell carcinoma: A case report. Taiwan J Obstet Gynecol 2024; 63:85-89. [PMID: 38216277 DOI: 10.1016/j.tjog.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVE Metastatic squamous cell carcinoma (SCC) of inguinal lymph node region with unknown origin is a rare condition. A patient was diagnosed to have vulvar SCC 7 years after the initial diagnosis of inguinal nodal metastatic SCC of unknown primary. CASE REPORT A 59-year-old woman with metastatic SCC of unknown origin in the right inguinal lymph node underwent tumor resection and no evidence of residual disease or possible tumor origin was detected after the surgery and a comprehensive work-up. Seven years later, she was diagnosed to have invasive right vulvar SCC with right pelvic lymph node metastasis. We performed a series of tests to evaluate the relationship between these two events. CONCLUSION According to our investigation, the possible relationship between the two events could not be ruled out. This case emphasizes the possibility of late recurrence and the importance of long-term follow up for patients with isolated nodal CUP.
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Affiliation(s)
- Jessica Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei City, Taiwan
| | - Tao-Yeuan Wang
- Department of Pathology, MacKay Memorial Hospital, Taipei City, Taiwan
| | - Chao-Chih Wu
- Department of Medical Research, MacKay Memorial Hospital, Tamshui, New Taipei City, Taiwan
| | - Yu-Chia Hsiao
- Department of Medical Research, MacKay Memorial Hospital, Tamshui, New Taipei City, Taiwan
| | - Chih-Long Chang
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei City, Taiwan; Department of Medical Research, MacKay Memorial Hospital, Tamshui, New Taipei City, Taiwan; Department of Medicine, MacKay Medical College, Sanchi, New Taipei City, Taiwan.
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Spinelli L, Martini S, Solla SD, Vigna Taglianti R, Olivero F, Gianello L, Reali A, Merlotti AM, Franco P. Nodal Elective Volume Selection and Definition during Radiation Therapy for Early Stage (T1-T2 N0 M0) Perianal Squamous Cell Carcinoma: A Narrative Clinical Review and Critical Appraisal. Cancers (Basel) 2023; 15:5833. [PMID: 38136378 PMCID: PMC10741760 DOI: 10.3390/cancers15245833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Distinction between anal canal and perianal squamous cell carcinomas (pSCCs) is essential, as these two subgroups have different anatomical, histological, and lymphatic drainage features. Early-stage true perianal tumors are very uncommon and have been rarely included in clinical trials. Perianal skin cancers and aCCs are included in the same tumor classification, even though they have different lymphatic drainage features. Furthermore, pSCCs are treated similarly to carcinomas originating from the anal canal. Radiation therapy (RT) is an essential treatment for anal canal tumors. Guidelines do not differentiate between treatment volumes for perianal tumors and anal cancers. So far, in pSCC, no study has considered modulating treatment volume selection according to the stage of the disease. We conducted a narrative literature review to describe the sites at higher risk for microscopic disease in patients with early-stage perianal cancers (T1-T2 N0 M0) to propose a well-thought selection of RT elective volumes.
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Affiliation(s)
- Lavinia Spinelli
- Radiation Oncology Department, Santa Croce and Carle Hospital, 12100 Cuneo, Italy; (L.S.); (S.M.); (S.D.S.); (R.V.T.); (F.O.); (L.G.); (A.M.M.)
| | - Stefania Martini
- Radiation Oncology Department, Santa Croce and Carle Hospital, 12100 Cuneo, Italy; (L.S.); (S.M.); (S.D.S.); (R.V.T.); (F.O.); (L.G.); (A.M.M.)
| | - Salvatore Dario Solla
- Radiation Oncology Department, Santa Croce and Carle Hospital, 12100 Cuneo, Italy; (L.S.); (S.M.); (S.D.S.); (R.V.T.); (F.O.); (L.G.); (A.M.M.)
| | - Riccardo Vigna Taglianti
- Radiation Oncology Department, Santa Croce and Carle Hospital, 12100 Cuneo, Italy; (L.S.); (S.M.); (S.D.S.); (R.V.T.); (F.O.); (L.G.); (A.M.M.)
| | - Francesco Olivero
- Radiation Oncology Department, Santa Croce and Carle Hospital, 12100 Cuneo, Italy; (L.S.); (S.M.); (S.D.S.); (R.V.T.); (F.O.); (L.G.); (A.M.M.)
| | - Luca Gianello
- Radiation Oncology Department, Santa Croce and Carle Hospital, 12100 Cuneo, Italy; (L.S.); (S.M.); (S.D.S.); (R.V.T.); (F.O.); (L.G.); (A.M.M.)
| | - Alessia Reali
- Radiation Oncology Department, Michele and Pietro Ferrero Hospital, 12060 Verduno, Italy;
| | - Anna Maria Merlotti
- Radiation Oncology Department, Santa Croce and Carle Hospital, 12100 Cuneo, Italy; (L.S.); (S.M.); (S.D.S.); (R.V.T.); (F.O.); (L.G.); (A.M.M.)
| | - Pierfrancesco Franco
- Department of Translational Medicine (DIMET), University of Eastern Piedmont, 28100 Novara, Italy
- Department of Radiation Oncology, ‘Maggiore della Carità’ University Hospital, 28100 Novara, Italy
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Nilsson MP, Undseth C, Albertsson P, Eidem M, Havelund BM, Johannsson J, Johnsson A, Radu C, Serup-Hansen E, Spindler KL, Zakrisson B, Guren MG, Kronborg C. Nordic anal cancer (NOAC) group consensus guidelines for risk-adapted delineation of the elective clinical target volume in anal cancer. Acta Oncol 2023; 62:897-906. [PMID: 37504978 DOI: 10.1080/0284186x.2023.2240490] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023]
Abstract
Background: To date, anal cancer patients are treated with radiotherapy to similar volumes despite a marked difference in risk profile based on tumor location and stage. A more individualized approach to delineation of the elective clinical target volume (CTVe) could potentially provide better oncological outcomes as well as improved quality of life. The aim of the present work was to establish Nordic Anal Cancer (NOAC) group guidelines for delineation of the CTVe in anal cancer.Methods: First, 12 radiation oncologists reviewed the literature in one of the following four areas: (1) previous delineation guidelines; (2) patterns of recurrence; (3) anatomical studies; (4) common iliac and para-aortic recurrences and delineation guidelines. Second, areas of controversy were identified and discussed with the aim of reaching consensus.Results: We present consensus-based recommendations for CTVe delineation in anal cancer regarding (a) which regions to include, and (b) how the regions should be delineated. Some of our recommendations deviate from current international guidelines. For instance, the posterolateral part of the inguinal region is excluded, decreasing the volume of irradiated normal tissue. For the external iliac region and the cranial border of the CTVe, we agreed on specifying two different recommendations, both considered acceptable. One of these recommendations is novel and risk-adapted; the external iliac region is omitted for low-risk patients, and several different cranial borders are used depending on the individual level of risk.Conclusion: We present NOAC consensus guidelines for delineation of the CTVe in anal cancer, including a risk-adapted strategy.
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Affiliation(s)
- Martin P Nilsson
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | | | - Per Albertsson
- Department of Oncology, Sahlgrenska University Hospital, Region Västra Götaland, and Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Monika Eidem
- Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Norway
| | - Birgitte Mayland Havelund
- Department of Oncology, University Hospital of Southern Denmark, Lillebaelt Hospital, Vejle, Denmark
| | - Jakob Johannsson
- Department of Radiation Oncology, Landspitali University Hospital, Reykjavik, Iceland
| | - Anders Johnsson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Calin Radu
- Department of Immunology, Genetics and Pathology, Uppsala University, Sweden
| | - Eva Serup-Hansen
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | | | - Björn Zakrisson
- Department of radiation sciences - oncology, Umeå University
| | - Marianne G Guren
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Camilla Kronborg
- Danish, Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Dei D, Lambri N, Stefanini S, Vernier V, Brioso RC, Crespi L, Clerici E, Bellu L, De Philippis C, Loiacono D, Navarria P, Reggiori G, Bramanti S, Rodari M, Tomatis S, Chiti A, Carlo-Stella C, Scorsetti M, Mancosu P. Internal Guidelines for Reducing Lymph Node Contour Variability in Total Marrow and Lymph Node Irradiation. Cancers (Basel) 2023; 15:cancers15051536. [PMID: 36900326 PMCID: PMC10000500 DOI: 10.3390/cancers15051536] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/21/2023] [Accepted: 02/24/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND The total marrow and lymph node irradiation (TMLI) target includes the bones, spleen, and lymph node chains, with the latter being the most challenging structures to contour. We evaluated the impact of introducing internal contour guidelines to reduce the inter- and intraobserver lymph node delineation variability in TMLI treatments. METHODS A total of 10 patients were randomly selected from our database of 104 TMLI patients so as to evaluate the guidelines' efficacy. The lymph node clinical target volume (CTV_LN) was recontoured according to the guidelines (CTV_LN_GL_RO1) and compared to the historical guidelines (CTV_LN_Old). Both topological (i.e., Dice similarity coefficient (DSC)) and dosimetric (i.e., V95 (the volume receiving 95% of the prescription dose) metrics were calculated for all paired contours. RESULTS The mean DSCs were 0.82 ± 0.09, 0.97 ± 0.01, and 0.98 ± 0.02, respectively, for CTV_LN_Old vs. CTV_LN_GL_RO1, and between the inter- and intraobserver contours following the guidelines. Correspondingly, the mean CTV_LN-V95 dose differences were 4.8 ± 4.7%, 0.03 ± 0.5%, and 0.1 ± 0.1%. CONCLUSIONS The guidelines reduced the CTV_LN contour variability. The high target coverage agreement revealed that historical CTV-to-planning-target-volume margins were safe, even if a relatively low DSC was observed.
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Affiliation(s)
- Damiano Dei
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Nicola Lambri
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
- Correspondence: (N.L.); (S.T.)
| | - Sara Stefanini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Veronica Vernier
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Ricardo Coimbra Brioso
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 20133 Milan, Italy
| | - Leonardo Crespi
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 20133 Milan, Italy
- Health Data Science Centre, Human Technopole, 20157 Milan, Italy
| | - Elena Clerici
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Luisa Bellu
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Chiara De Philippis
- Department of Oncology and Hematology, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Daniele Loiacono
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 20133 Milan, Italy
| | - Pierina Navarria
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Giacomo Reggiori
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Stefania Bramanti
- Department of Oncology and Hematology, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Marcello Rodari
- Department of Nuclear Medicine, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Stefano Tomatis
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
- Correspondence: (N.L.); (S.T.)
| | - Arturo Chiti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Department of Nuclear Medicine, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Carmelo Carlo-Stella
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Department of Oncology and Hematology, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Marta Scorsetti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Pietro Mancosu
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
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7
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Added Value of Abnormal Lymph Nodes Detected with FDG-PET/CT in Suspected Vascular Graft Infection. BIOLOGY 2023; 12:biology12020251. [PMID: 36829528 PMCID: PMC9953627 DOI: 10.3390/biology12020251] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/08/2023]
Abstract
Vascular graft and endograft infections (VGEI) cause a serious morbidity and mortality burden. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) imaging is frequently used in the diagnostic workup, but the additional value of abnormal (18F-FDG active and/or enlarged) locoregional lymph nodes is unknown. In this retrospective study, the additional diagnostic value of abnormal locoregional lymph nodes on 18F-FDG PET/CT imaging for VGEI was evaluated, including 54 patients with a culture-proven VGEI (defined according to the Management of Aortic Graft Infection [MAGIC] group classification) and 25 patients without VGEI. 18F-FDG PET/CT was qualitatively and quantitatively assessed for tracer uptake and pattern at the location of the vascular graft, and locoregional lymph node uptake and enlargement (>10 mm). 18F-FDG uptake intensity and pattern independently predicted the presence of VGEI by logistic regression (Χ2: 46.19, p < 0.001), with an OR of 7.38 (95% CI [1.65, 32.92], p = 0.009) and 18.32 (95% CI [3.95, 84.88], p < 0.001), respectively. Single visual assessment of abnormal locoregional lymph nodes predicted the presence of VGEI with a sensitivity of 35%, specificity of 96%, PPV of 95%, and NPV of 41%. The visual assessment of abnormal lymph nodes after qualitative assessment of 18F-FDG uptake intensity and pattern at the vascular graft location did not independently predict the presence of VGEI by logistic regression (Χ2: 3.60, p = 0.058; OR: 8.25, 95% CI [0.74, 63.37], p = 0.096). In conclusion, detection of abnormal locoregional lymph nodes on 18F-FDG PET/CT has a high specificity (96%) and PPV (95%) for VGEI. However, it did not add to currently used 18F-FDG PET/CT interpretation criteria.
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8
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Sato H, Maeda K, Kinugasa Y, Kagawa H, Tsukamoto S, Takahashi K, Nozawa H, Takii Y, Konishi T, Akagi Y, Suto T, Yamaguchi S, Ozawa H, Komori K, Ohue M, Hiro J, Shinji S, Minami K, Shimizu T, Sakamoto K, Uehara K, Takahashi H, Sugihara K. Management of inguinal lymph node metastases from rectal and anal canal adenocarcinoma. Colorectal Dis 2022; 24:1150-1163. [PMID: 35505622 DOI: 10.1111/codi.16169] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 02/08/2023]
Abstract
AIM The surgical treatment of inguinal lymph node (ILN) metastases secondary to anorectal adenocarcinoma remains controversial. This study aimed to clarify the surgical treatment and management of ILN metastasis according to its classification. METHODS This retrospective, multi-centre, observational study included patients with synchronous or metachronous ILN metastases who were diagnosed with rectal or anal canal adenocarcinoma between January 1997 and December 2011. Treatment outcomes were analysed according to recurrence and prognosis. RESULTS Among 1181 consecutively enrolled patients who received treatment for rectal or anal canal adenocarcinoma at 20 referral hospitals, 76 (6.4%) and 65 (5.5%) had synchronous and metachronous ILN metastases, respectively. Among 141 patients with ILN metastasis, differentiated carcinoma, solitary ILN metastasis and ILN dissection were identified as independent predictive factors associated with a favourable prognosis. No significant difference was found in the frequency of recurrence after ILN dissection between patients with synchronous (80.6%) or metachronous (81.0%) ILN metastases. Patients who underwent R0 resection of the primary tumour and ILN dissection had a 5-year survival rate of 41.3% after ILN dissection (34.1% and 53.1% for patients with synchronous and metachronous ILN metastases, respectively, P = 0.55). CONCLUSION The ILN can be appropriately classified as a regional lymph node in rectal and anal canal adenocarcinoma. Moreover, aggressive ILN dissection might be effective in improving the prognosis of low rectal and anal canal adenocarcinoma with ILN metastases; thus, prophylactic ILN dissection is unnecessary.
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Affiliation(s)
- Harunobu Sato
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kotaro Maeda
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,International Medical Center, Fujita Health University Hospital, Toyoake, Japan
| | - Yusuke Kinugasa
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroyasu Kagawa
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Division of Colon and Rectal Surgery, Shizuoka Cancer Center, Sunto-gun, Japan
| | - Shunsuke Tsukamoto
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Keiichi Takahashi
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.,Department of Surgery, Tokyo Metropolitan Health and Hospitals Corporation Ohkubo Hospital, Tokyo, Japan
| | - Hiroaki Nozawa
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Yasumasa Takii
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Gastroenterological Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Tsuyoshi Konishi
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.,Department of Colon and Rectal Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yoshito Akagi
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Takeshi Suto
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Gastroenterological Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Shigeki Yamaguchi
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Colorectal Surgery, Saitama Medical University International Medical Center, Saitama, Japan.,Division of Colorectal Surgery, Department of Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Heita Ozawa
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Surgery, Tochigi Cancer Center, Tochigi, Japan
| | - Koji Komori
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Masayuki Ohue
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Junichiro Hiro
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan.,Division of Reparative Medicine, Department of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Japan
| | - Seiichi Shinji
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - Kazuhito Minami
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Tomoharu Shimizu
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Division of Medical Safety Section, Shiga University of Medical Science, Otsu, Japan
| | - Kazuhiro Sakamoto
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kay Uehara
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Takahashi
- Department of Medical Statistics, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kenichi Sugihara
- Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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9
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Evaluation and external validation of minor lymphatic pelvic pathway for distant metastases in cervical cancer patients treated with concurrent chemoradiotherapy. Curr Probl Cancer 2022; 46:100876. [DOI: 10.1016/j.currproblcancer.2022.100876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/08/2022] [Accepted: 05/09/2022] [Indexed: 12/13/2022]
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10
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ECOG-ACRIN Guideline for Contouring and Treatment of Early Stage Anal Cancer Using IMRT/IGRT. Pract Radiat Oncol 2022; 12:335-347. [PMID: 35717050 DOI: 10.1016/j.prro.2022.01.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE Previous anal cancer guidelines delineate target volumes similarly for all patients with squamous cell carcinoma of the anal canal and/or perianal skin (SCCA), regardless of disease stage. The purpose of this guideline is to provide customized radiation treatment recommendations for early stage (T1-2 N0 M0) anal cancer treated with intensity modulated and image guided radiation therapy (RT). METHODS AND MATERIALS A contouring atlas and radiation treatment recommendations for the ongoing, randomized phase II trial of deintensified chemoradiation for early stage SCCA (EA2182) was created by an expert panel of radiation oncologists. A literature search was conducted to update and expand these recommendations into a guideline for routine clinical use. RESULTS For the majority of cases, we recommend treatment in the supine, frog leg position with the use of a customized immobilization device and daily image guided RT to ensure optimal bone and soft tissue alignment. Vaginal dilators can be used daily during RT to maximize genitalia sparing. We recommend use of a 10-mm margin on the gross tumor plus including the anal complex to create the primary clinical target volume. To define the elective lymph node clinical target volume, we recommend starting with a 7-mm expansion on blood vessels, but then further refining these volumes based on the anatomic location. A 5- to 10-mm planning target volume (PTV) margin is suggested based on institutional setup and patient-specific factors. When using a simultaneous integrated boost technique, a dose of 50.4 Gy to primary PTV and 42 Gy to lymph node PTV, both delivered over 28 fractions, with chemotherapy is appropriate for early stage anal cancer. CONCLUSIONS This guideline provides anatomic, clinical, and technical instructions to guide radiation oncologists in the planning and delivery of intensity modulated and image guided RT for early stage SCCA.
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11
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Wagner JM, Dadras M, Ufton D, Huber J, Wallner C, Sogorski A, von Glinski M, Hong JP, Lehnhardt M, Behr B. Prophylactic lymphaticovenous anastomoses for resection of soft tissue tumors of the thigh to prevent secondary lymphedema-a retrospective comparative cohort analysis. Microsurgery 2021; 42:239-245. [PMID: 34951055 DOI: 10.1002/micr.30850] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 10/04/2021] [Accepted: 12/08/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Patients with soft tissue tumors of extremities are at risk to develop secondary lymphedema after tumor resection caused by disruption of lymphatic vessels and sclerosis. Subsequently, this study aimed to evaluate the beneficial effects of lymphaticovenous anastomoses (LVAs) after soft tissue tumor resection of the thigh in a prophylactic approach. METHODS In a retrospective cohort study, we compared eight patients with a median age of 68.5 years (49-80) who received LVAs in combination with tumor resection for treatment of soft tissue tumors of the thigh region with a prior cohort of 20 patients with a median age of 63.0 years (23-84) who received soft tissue sarcoma resection of the thigh region. All patients of LVA cohort received 1-2 LVAs (mean 1.25 ± 0.49) at the dorsum of the foot and three patients at the SEKI-point (mean 0.375 ± 0.51). Mean maximum tumor diameter of LVA group was 19.5 ± 5.2 cm and 12.3 ± 6.6 cm of control group. All patients receiving LVA were assessed for development of lymphedema via bilateral measurements of circumference and assessment of lymphedema quality of life index (LyQLI). RESULTS One of the eight patients who received LVAs showed moderate impairment in the LyQLI at a follow-up of 12 months while 45% of the control cohort complained about symptoms of secondary lymphedema at a median follow-up of 22 months (p-values LyQLI: p = .018 [physical domain]; p = .018 [psychosocial domain]; p = .020 [practical domain]). CONCLUSION LVAs performed in combination with tumor resection of thigh soft tissue tumors reduce negative consequences of lymph stasis and prevent development of secondary lymphedema.
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Affiliation(s)
- Johannes Maximilian Wagner
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Mehran Dadras
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Dominic Ufton
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Julika Huber
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Christoph Wallner
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Alexander Sogorski
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Maxi von Glinski
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Joon Pio Hong
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Seoul, South Korea
| | - Marcus Lehnhardt
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Björn Behr
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
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12
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Masahata K, Ichikawa C, Higuchi K, Makino K, Abe T, Kim K, Yamamichi T, Tayama A, Soh H, Usui N. A Rare Case of Immature Sacrococcygeal Teratoma With Lymph Node Metastasis in a Neonate. J Pediatr Hematol Oncol 2021; 43:e1186-e1190. [PMID: 33323883 DOI: 10.1097/mph.0000000000002042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/20/2020] [Indexed: 11/27/2022]
Abstract
This is the first report of an immature sacrococcygeal teratoma with inguinal lymph node metastasis, providing the histologic transformation of an immature teratoma in association with chemotherapy. Incomplete tumor resection with coccygectomy was performed, and the histopathologic diagnosis was a grade 3 immature teratoma. Following the initial surgery, the residual tumors enlarged and the tumors metastasized to the inguinal lymph node, demonstrating immature teratoma without yolk sac tumor components. Although the tumor markers normalized after chemotherapy, the residual tumors had enlarged significantly. Therefore, a complete resection of the residual tumors was performed, and they were found to be mature teratomas.
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Affiliation(s)
- Kazunori Masahata
- Departments of Pediatric Surgery
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | | | - Kohei Higuchi
- Hematology/Oncology, Osaka Women's and Children's Hospital, Izumi
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13
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Dee EC, Byrne JD, Wo JY. Evolution of the Role of Radiotherapy for Anal Cancer. Cancers (Basel) 2021; 13:1208. [PMID: 33801992 PMCID: PMC8001637 DOI: 10.3390/cancers13061208] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/05/2021] [Accepted: 03/06/2021] [Indexed: 12/11/2022] Open
Abstract
Prior to the 1980s, the primary management of localized anal cancer was surgical resection. Dr. Norman Nigro and colleagues introduced neoadjuvant chemoradiotherapy prior to abdominoperineal resection. Chemoradiotherapy 5-fluorouracil and mitomycin C afforded patients complete pathologic response and obviated the need for upfront surgery. More recent studies have attempted to alter or exclude chemotherapy used in the Nigro regimen to mitigate toxicity, often with worse outcomes. Reductions in acute adverse effects have been associated with marked advancements in radiotherapy delivery using intensity-modulated radiation therapy (IMRT) and image-guidance radiation delivery, resulting in increased tolerance to greater radiation doses. Ongoing trials are attempting to improve IMRT-based treatment of locally advanced disease with efforts to increase personalized treatment. Studies are also examining the role of newer treatment modalities such as proton therapy in treating anal cancer. Here we review the evolution of radiotherapy for anal cancer and describe recent advances. We also elaborate on radiotherapy's role in locally persistent or recurrent anal cancer.
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Affiliation(s)
| | - James D. Byrne
- Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA 02115, USA;
| | - Jennifer Y. Wo
- Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA;
- Department of Radiation Oncology, Massachusetts General Hospital, 100 Blossom St., Boston, MA 02114, USA
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14
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Raskin D, Khaitovich B, Balan S, Silverberg D, Rmeileh AA, Halak M, Rimon U. Inguinal lymphadenopathy as a predicting factor for ipsilateral primary limb amputation after a successful endovascular treatment. Eur J Radiol 2020; 130:109162. [PMID: 32659616 DOI: 10.1016/j.ejrad.2020.109162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 06/08/2020] [Accepted: 06/30/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the correlation between inguinal lymph node characteristics and ipsilateral limb amputation rates in patients with ischemic foot ulcers after a successful endovascular treatment. METHOD A retrospective review of patients who were endovascularly treated for ischemic foot ulcers between January 2015 and May 2017. Technical success was defined as arterial recanalization with stenosis less than 30 % and ankle brachial index improvement by > 0.2 after 24 h. Unilateral lymph node size, contrast enhancement, necrosis, and perinodular fat stranding were assessed on pre-procedural CTA. Primary endpoints were amputation and sepsis within 12 months following treatment. The relationship between lymph node characteristics and limb amputation and septic shock were examined. RESULTS Endovascular treatment of 202 limbs in 202 patients (135 males; median age 72.8 years [42.2-93.7]) was technically successful. Forty-two (20.8 %) patients underwent amputation, six (3 %) patients had septic shock. There was a significant difference in lymph node sizes between the amputated and the non-amputated limbs (P = 0.000). Lymph node characteristics (size, enhancement, necrosis, and perinodular fat stranding) were significantly related to amputation (P < 0.001). Patients with perinodular fat stranding or increased node size were 5.940 and 1.109 times more likely to undergo limb amputation, respectively. Lymph node characteristics were also significantly related to septic shock (P < 0.05). CONCLUSIONS Certain lymph node characteristics are associated with amputation in patients with ischemic foot ulcers, after a technically successful endovascular treatment of the limb. Large lymph node size and perinodular fat stranding are predictive of limb amputation.
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Affiliation(s)
- Daniel Raskin
- Departments of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Boris Khaitovich
- Departments of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shmuel Balan
- Departments of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Daniel Silverberg
- Vascular Surgery, Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ahmad Abu Rmeileh
- Vascular Surgery, Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Moshe Halak
- Vascular Surgery, Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Uri Rimon
- Departments of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Li X, Cui M, Gu X, Fang D, Li H, Qin S, Yang K, Zhu T, Li X, Zhou L, Gao XS, Wang D. Pattern and risk factors of local recurrence after nephroureterectomy for upper tract urothelial carcinoma. World J Surg Oncol 2020; 18:114. [PMID: 32473636 PMCID: PMC7261378 DOI: 10.1186/s12957-020-01877-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 05/11/2020] [Indexed: 01/20/2023] Open
Abstract
Purpose This study aims to identify predictive local recurrence risk factors and site-specific local recurrence pattern of upper tract urothelial carcinoma (UTUC) with different primary tumor locations. Methods Three hundred and eighty-nine UTUC patients with radical nephroureterectomy were included in this study. Univariate and multivariate Cox proportional hazards regressions were performed to measure the risk of local recurrence. We also mapped the position of local recurrence sites stratified by primary tumor locations. Results A total of 73 patients (18.7%) developed local recurrence within a median follow-up of 41 months (range, 3-80 months). For patients with local recurrence, the median interval of local recurrence was 9 months. Ureter tumor, multifocality, T stage, G grade, lymph node metastasis (LNM), lymph node dissection (LND), and lymph vascular invasion (LVI) were all significantly associated with increased local recurrence by univariable analyses (P < 0.05). Only multifocality, T3–4, G3, and LNM remained independent predictors of increased local recurrence by multivariable analyses. Adjuvant radiotherapy could reduce the local recurrence (HR = 0.177; 95% CI 0.064-0.493, P = 0.001). Patients with local recurrence had poorer cancer-specific survival (4-year cancer-specific survival rate 36 ± 7.5% vs 88.4 ± 2.2%, P = 0.000). We evaluated local recurrence pattern stratified by tumor locations. Para-aortic lymph node region was the most common recurrence area for all the patients. Left-sided UTUC had more than 70% recurrent lymph nodes in the left para-aortic region (LPA). For right-sided UTUC patients, recurrent para-aortic lymph nodes distributed in the LPA (33.3%), aortocaval (AC) (41.5%), and right paracaval (RPC) (25.2%) regions. Recurrence in the internal and external iliac regions was only found in the distal ureter group (P < 0.05). Renal pelvic fossa recurrence was only found in renal pelvic tumor (22.2%, P = 0.007). The ureter tumor bed recurrence rate was higher for ureter patients (P = 0.001). Conclusions Multifocality, T3–4, G3, and LNM are predictors of higher local recurrence rate of UTUC. Adjuvant radiotherapy can reduce local recurrence rate. Local recurrence patterns are different according to primary tumor locations.
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Affiliation(s)
- Xiaoying Li
- Department of Radiation Oncology, Peking University First Hospital, Peking University, Beijing, China
| | - Ming Cui
- Department of Radiation Oncology, Peking University First Hospital, Peking University, Beijing, China
| | - Xiaobin Gu
- Department of Radiation Oncology, Peking University First Hospital, Peking University, Beijing, China
| | - Dong Fang
- Department of Urology, Peking University First Hospital, Peking University, Beijing, China
| | - Hongzhen Li
- Department of Radiation Oncology, Peking University First Hospital, Peking University, Beijing, China
| | - Shangbin Qin
- Department of Radiation Oncology, Peking University First Hospital, Peking University, Beijing, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Peking University, Beijing, China
| | - Tianzhao Zhu
- Department of Medical Imaging, Peking University First Hospital, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Peking University, Beijing, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Peking University, Beijing, China.
| | - Xian-Shu Gao
- Department of Radiation Oncology, Peking University First Hospital, Peking University, Beijing, China.
| | - Dian Wang
- Department of Radiation Oncology, Rush University Medical Center , Chicago, USA
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Analysis of collateral lymphatic circulation in patients with lower limb lymphedema using magnetic resonance lymphangiography. J Vasc Surg Venous Lymphat Disord 2020; 9:471-481.e1. [PMID: 32470617 DOI: 10.1016/j.jvsv.2020.04.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/29/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Although the development of lymphatic collaterals is expected following lymphedema, little is known about the anatomic details of such compensatory pathways or their association with symptoms. Magnetic resonance lymphangiography (MRL) has been shown to be superior to lymphoscintigraphy and indocyanine green lymphography in visualizing lymphatics. This study aimed to analyze MRL images of lower limbs to elucidate the patterns of lymphatic collateral formation and their association with the clinical stages of lymphedema. METHODS We enrolled 56 consecutive patients (112 lower limbs) with lymphedema who underwent MRL. Two radiologists performed a consensus reading of MRL images for the presence or absence of collateral lymphatic pathways, and the results were compared with the clinical stages. Furthermore, the frequency of abnormal MRL findings in 43 asymptomatic lower limbs of patients with unilateral lymphedema was analyzed and compared with that in the 69 symptomatic lower limbs of the patients. The imaging findings were also compared with the cause of lymphedema. RESULTS All three collateral pathways (anterolateral, deep, and posteromedial lymphatics) were visualized at a higher (P < .05) frequency in stage II than in stage 0 lower limbs. The frequency of visualization of the three collaterals was significantly higher in symptomatic (stages I-III) lower limbs than in asymptomatic (stage 0) lower limbs. Most (76.8%) of the symptomatic limbs exhibited at least one of these collaterals, and the frequency was significantly higher than in the asymptomatic limbs (P < .001). Most (81.4%) of the asymptomatic (stage 0) lower limbs had at least one abnormal finding in terms of lymphatic circulation, although this proportion was significantly lower compared with the symptomatic limbs (98.6%). The collaterals tended to appear less frequently in primary lymphedema than in secondary lymphedema, reaching statistical significance in the posteromedial lymphatics. CONCLUSIONS These results suggested that the two superficial lymphatic groups and the deep lymphatic system act as major collaterals of the lower limbs in patients with lymphedema. Furthermore, MRL of most patients with unilateral lymphedema demonstrated abnormal findings, including collateral formation, not only in the affected lower limb but also in the asymptomatic lower limb. In primary lymphedema, the collaterals may appear less frequently than in secondary lymphedema. Collaterals should be taken into consideration in planning the site of lymphaticovenous anastomosis and assessing disease progression. MRL can visualize preclinical alterations in lymphatic flow and compensatory pathways; therefore, we expect that it will be useful for the early diagnosis of lymphedema.
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Tanabe T, Shida D, Komukai S, Nakamura Y, Tsukamoto S, Kanemitsu Y. Long-term outcomes after surgical dissection of inguinal lymph node metastasis from rectal or anal canal adenocarcinoma. BMC Cancer 2019; 19:733. [PMID: 31340778 PMCID: PMC6657054 DOI: 10.1186/s12885-019-5956-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 07/18/2019] [Indexed: 12/02/2022] Open
Abstract
Background The 8th edition of the tumor-node-metastasis (TNM) classification classifies inguinal lymph nodes as regional lymph nodes for anal canal carcinoma but non-regional lymph nodes for rectal carcinoma. This difference might reflect the different prognosis of inguinal lymph node metastasis from anal canal carcinoma and rectal carcinoma. However, long-term outcomes of inguinal lymph node metastasis from rectal or anal canal adenocarcinoma are unclear, which we aimed to investigate in this study. Methods The study population included 31 consecutive patients with rectal or anal canal adenocarcinoma who underwent inguinal lymph node dissection with curative intent at the National Cancer Center Hospital from 1986 to 2017. Long-term outcomes were assessed and clinicopathologic variables analyzed for prognostic significance. Results Of the 31 patients, 12 patients had rectal adenocarcinoma and 19 patients had anal canal adenocarcinoma. Synchronous metastasis were observed in 14 patients and metachronous metastasis in 17 patients. After dissection of inguinal lymph node metastasis with curative intent, the 5-year overall survival rate was 55.2%, with 12 patients surviving for more than 5 years. Median survival time was 66.6 months. Multivariate analyses revealed that location of primary tumor (rectum versus anal canal) was not a prognostic factor, whereas lateral lymph node metastasis and histological findings were independent prognostic factors. Conclusion Given the good prognosis, inguinal lymph node metastasis in patients with rectal or anal canal adenocarcinoma appears to be regional rather than distant. If R0 resection can be achieved, inguinal lymph node dissection may be indicated for these patients.
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Affiliation(s)
- Taro Tanabe
- Department of Colorectal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan
| | - Dai Shida
- Department of Colorectal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan.
| | - Sho Komukai
- Division of Biomedical Statistics, Department of Integrated Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yuya Nakamura
- Department of Colorectal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan
| | - Shunsuke Tsukamoto
- Department of Colorectal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan
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Kito M, Ae K, Koyanagi H, Gokita T, Furuoka H, Okamoto M, Tanaka A, Suzuki S, Takazawa A, Aoki K, Yoshimura Y. Risk factor for wound complications following wide resection of soft tissue sarcoma in the adductor compartment of the thigh. Jpn J Clin Oncol 2019; 49:932-937. [DOI: 10.1093/jjco/hyz101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/03/2019] [Accepted: 06/19/2019] [Indexed: 12/14/2022] Open
Abstract
Abstract
Background
The purpose of this study was to investigate deep-seated soft tissue sarcoma (STS) occurring in the adductor compartment of the thigh that underwent wide resection and to clarify the high-risk group for wound complications.
Patients and methods
From 2000 to 2017, we reviewed 104 cases of deep-seated STS occurring in the adductor compartment of the thigh that were treated at four specialized facilities with expertise in sarcoma treatment.
Results
Wound complications occurred in 40 cases (38.5%), of which 23 cases (22.1%) were cases with major wound complications (MWC). In univariate analysis, BMI (P < 0.01), maximum tumor diameter (P < 0.01), operation time (P < 0.01), amount of intraoperative bleeding (P < 0.01), and intraoperative intervention to the femoral artery and vein (P < 0.01) were significantly associated with wound complications. In multivariate analysis, the associated parameters were BMI (P < 0.01), maximum tumor diameter (P = 0.02), and intraoperative intervention to the femoral artery and vein (P = 0.01). When limited to cases with MWC, univariate analysis showed that maximum tumor diameter (P < 0.01), diabetes mellitus (P = 0.03), operation time (P < 0.01), amount of intraoperative bleeding (P < 0.01), and intraoperative intervention to the femoral artery and vein (P = 0.02) were significantly associated parameters. In multivariate analysis, maximum tumor diameter (P = 0.02) and amount of intraoperative bleeding (P = 0.04) were associated parameters.
Conclusions
For patients with risk factors for wound complications, control of bleeding are crucial when resecting deep-seated STS in the adductor compartment of the thigh. In cases with large tumors, surgeons should be especially cautious of cases requiring interventions that surround the femoral artery and vein in order to attain an appropriate surgical margin.
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Affiliation(s)
- Munehisa Kito
- Department of Orthopaedic Surgery, Shinshu University School of Medicine
| | - Keisuke Ae
- Department of Orthopaedic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research
| | - Hirotaka Koyanagi
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University
| | - Tabu Gokita
- Department of Orthopaedic Surgery, Saitama Cancer Center
| | - Hideto Furuoka
- Department of Orthopaedic Surgery, Saitama Cancer Center
| | - Masanori Okamoto
- Department of Orthopaedic Surgery, Shinshu University School of Medicine
| | - Atsushi Tanaka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine
| | - Shuichiro Suzuki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine
| | - Akira Takazawa
- Department of Orthopaedic Surgery, Shinshu Ueda Medical Center
| | - Kaoru Aoki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine
| | - Yasuo Yoshimura
- Department of Orthopaedic Surgery, Shinshu Ueda Medical Center
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(68Ga)-PSMA-PET/CT for the detection of postoperative prostate cancer recurrence: Possible implications on treatment volumes for radiation therapy. Cancer Radiother 2019; 23:194-200. [DOI: 10.1016/j.canrad.2018.09.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/04/2018] [Accepted: 09/09/2018] [Indexed: 12/20/2022]
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Bibault JE, Zapletal E, Rance B, Giraud P, Burgun A. Labeling for Big Data in radiation oncology: The Radiation Oncology Structures ontology. PLoS One 2018; 13:e0191263. [PMID: 29351341 PMCID: PMC5774757 DOI: 10.1371/journal.pone.0191263] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 01/01/2018] [Indexed: 12/25/2022] Open
Abstract
Purpose Leveraging Electronic Health Records (EHR) and Oncology Information Systems (OIS) has great potential to generate hypotheses for cancer treatment, since they directly provide medical data on a large scale. In order to gather a significant amount of patients with a high level of clinical details, multicenter studies are necessary. A challenge in creating high quality Big Data studies involving several treatment centers is the lack of semantic interoperability between data sources. We present the ontology we developed to address this issue. Methods Radiation Oncology anatomical and target volumes were categorized in anatomical and treatment planning classes. International delineation guidelines specific to radiation oncology were used for lymph nodes areas and target volumes. Hierarchical classes were created to generate The Radiation Oncology Structures (ROS) Ontology. The ROS was then applied to the data from our institution. Results Four hundred and seventeen classes were created with a maximum of 14 children classes (average = 5). The ontology was then converted into a Web Ontology Language (.owl) format and made available online on Bioportal and GitHub under an Apache 2.0 License. We extracted all structures delineated in our department since the opening in 2001. 20,758 structures were exported from our “record-and-verify” system, demonstrating a significant heterogeneity within a single center. All structures were matched to the ROS ontology before integration into our clinical data warehouse (CDW). Conclusion In this study we describe a new ontology, specific to radiation oncology, that reports all anatomical and treatment planning structures that can be delineated. This ontology will be used to integrate dosimetric data in the Assistance Publique—Hôpitaux de Paris CDW that stores data from 6.5 million patients (as of February 2017).
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Affiliation(s)
- Jean-Emmanuel Bibault
- Radiation Oncology Department, Georges Pompidou European Hospital, Assistance Publique – Hôpitaux de Paris (AP-HP), Paris Descartes University, Paris Sorbonne Cité, Paris, France
- INSERM UMR 1138 Team 22: Information Sciences to support Personalized Medicine, Paris Descartes University, Sorbonne Paris Cité, Paris, France
- * E-mail:
| | - Eric Zapletal
- Biomedical Informatics and Public Health Department, Georges Pompidou European Hospital, Assistance Publique – Hôpitaux de Paris (AP-HP), Paris Descartes University, Paris Sorbonne Cité, Paris, France
| | - Bastien Rance
- INSERM UMR 1138 Team 22: Information Sciences to support Personalized Medicine, Paris Descartes University, Sorbonne Paris Cité, Paris, France
- Biomedical Informatics and Public Health Department, Georges Pompidou European Hospital, Assistance Publique – Hôpitaux de Paris (AP-HP), Paris Descartes University, Paris Sorbonne Cité, Paris, France
| | - Philippe Giraud
- Radiation Oncology Department, Georges Pompidou European Hospital, Assistance Publique – Hôpitaux de Paris (AP-HP), Paris Descartes University, Paris Sorbonne Cité, Paris, France
| | - Anita Burgun
- INSERM UMR 1138 Team 22: Information Sciences to support Personalized Medicine, Paris Descartes University, Sorbonne Paris Cité, Paris, France
- Biomedical Informatics and Public Health Department, Georges Pompidou European Hospital, Assistance Publique – Hôpitaux de Paris (AP-HP), Paris Descartes University, Paris Sorbonne Cité, Paris, France
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Radiation Therapy in Anal Cancer. Radiat Oncol 2018. [DOI: 10.1007/978-3-319-52619-5_48-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Lymphocele Following Liposuction in the Thigh. Aesthetic Plast Surg 2017; 41:1408-1412. [PMID: 28664307 DOI: 10.1007/s00266-017-0930-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 06/21/2017] [Indexed: 10/19/2022]
Abstract
Lymphocele has not been reported as a complication after liposuction. In this study, we present the case of a patient who developed a cystic lesion after liposuction in her right thigh. The cyst could contract and evolve. The diagnosis of pseudobursa seroma (late seroma) was first considered. However, lymphoscintigraphy showed that lymphatic fluid accumulated in the cyst, and lymphatic vessel connected with it. The final diagnose was a lymphocele. After interventional therapy and conservative treatment failed, the lymphocele was resected. The subcutaneous soft tissue around the cyst was divided into bundles and then ligated with the purpose of blocking lymph leakage from the lymphatic duct. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Kwak YK, Lee SW, Kay CS, Park HH. Intensity-modulated radiotherapy reduces gastrointestinal toxicity in pelvic radiation therapy with moderate dose. PLoS One 2017; 12:e0183339. [PMID: 28846718 PMCID: PMC5573121 DOI: 10.1371/journal.pone.0183339] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 08/02/2017] [Indexed: 12/25/2022] Open
Abstract
This retrospective study was performed to evaluate and compare gastrointestinal (GI) toxicities caused by conventional radiotherapy (cRT) and intensity modulated radiotherapy (IMRT) in 136 cancer patients treated with pelvic radiotherapy (RT) with moderate radiation dose in a single institution. A matched-pair analysis of the two groups was performed; each group included 68 patients. Conventional RT was delivered using the four-field box technique and IMRT was delivered with helical tomotherapy. The median daily dose was 1.8 Gy and the median total dose was 50.4 Gy (range 25.2–56 Gy). Primary end point was GI toxicity during and after RT. Secondary end point was factors that affect toxicity. Patients treated with IMRT had lower incidence of grade ≥ 2 acute GI toxicity compared to the patients treated with cRT (p = 0.003). The difference remained significant in multivariate analysis (p = 0.01). The incidence of chronic GI toxicity was not statistically different between the two groups, but the cRT group had higher incidence of grade 3 chronic GI toxicity. Based on our results, IMRT can reduce GI toxicity compared to cRT in the treatment of pelvic radiotherapy even with moderate radiation dose and this will enhance patients’ quality of life and treatment compliance.
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Affiliation(s)
- Yoo-Kang Kwak
- Department of Radiation Oncology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sea-Won Lee
- Department of Radiation Oncology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chul Seung Kay
- Department of Radiation Oncology, Incheon St. Mary’s Hospital, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea
- * E-mail:
| | - Hee Hyun Park
- Department of Radiation Oncology, Incheon St. Mary’s Hospital, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea
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Differentiating metastatic from nonmetastatic lymph nodes in cervical cancer patients using monoexponential, biexponential, and stretched exponential diffusion-weighted MR imaging. Eur Radiol 2017; 27:5272-5279. [DOI: 10.1007/s00330-017-4873-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 04/18/2017] [Accepted: 05/02/2017] [Indexed: 12/31/2022]
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Su Z, Guo ZW, Mao YP, Tang J, Lan XW, Xie FY, Li Q. Anal adenocarcinoma requires prophylactic inguinal nodal treatment: Results from a single Chinese institution. J Cancer 2017; 8:1097-1102. [PMID: 28529624 PMCID: PMC5436264 DOI: 10.7150/jca.17513] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 12/23/2016] [Indexed: 01/09/2023] Open
Abstract
Background: Literature pertaining to prophylactic inguinal nodal treatment for anal adenocarcinoma in China is scarce. Methods: In this retrospective study, we analyzed 126 patients from 1965 to 2015. Among these, 67 patients received surgery only, 18 patients received chemoradiotherapy only, 27 patients received a combination of both, and the remaining 14 patients received palliative treatment. Results: The median follow up period was 30 months. The 1-year, 3-year, and 5-year overall survival rates were 85.8%, 62.5%, and 43.4%, respectively. The 5-year overall survival was 46.9% for patients with negative inguinal lymph nodes and 19.1% for patients with positive inguinal lymph nodes (p=0.007). The overall 5-year inguinal node relapse-free survival was 83.0%. The 5-year inguinal node relapse-free survival was 87.5% for stage I, 86.9% for stage II, and 76.5% for stage III cancers. Among those with negative inguinal nodes, the 5-year inguinal node relapse-free survival was 85.7% for negative regional lymph nodes and 75.4% for positive regional lymph nodes (p=0.089). Conclusion: Inguinal lymph node is a high-risk subclinical area. Prophylactic inguinal nodal treatment is necessary for patients with anal adenocarcinoma irrespective of positive or negative inguinal lymph nodes.
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Affiliation(s)
- Zhen Su
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Zhan-Wen Guo
- Department of Radiation Oncology, The General Hospital of Shenyang Military Area Command, No.83, Wenhua Road, Shenhe District, Shenyang, Liaoning province, 110016, China
| | - Yan-Ping Mao
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Jie Tang
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Xiao-Wen Lan
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Fang-Yun Xie
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Qun Li
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
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Tomasoa NB, Meulendijks D, Nijkamp J, Cats A, Dewit L. Clinical outcome in patients treated with simultaneous integrated boost - intensity modulated radiation therapy (SIB-IMRT) with and without concurrent chemotherapy for squamous cell carcinoma of the anal canal. Acta Oncol 2016; 55:760-6. [PMID: 26878244 DOI: 10.3109/0284186x.2015.1124141] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background and purpose To retrospectively evaluate locoregional control (LRC), survival and toxicity in anal cancer patients treated with simultaneous integrated boost - intensity modulated radiation therapy (SIB-IMRT) ± concurrent chemotherapy. Methods and materials Patients with squamous cell anal carcinoma stage T1(≥1 cm)-4, N0-3, M0-1 were included. All patients were treated with SIB-IMRT to a total dose of 59.4 Gy delivered to the primary tumor and macroscopically involved lymph nodes and 49.5 Gy to elective lymph node areas. If macroscopic residual tumor was still present in the fifth week of irradiation, a sequential boost of 5.4 Gy was given. Concurrent chemotherapy was administered in locally advanced cases. Acute and late toxicity were scored. Results One hundred and six patients treated consecutively between April 2006 and December 2012 were included. Eighty-seven (82.1%) patients received concurrent chemotherapy. The median follow-up was 47 months (range 2-104 months). Ninety-eight patients reached a clinical complete response (92.5%). Four-year actuarial LRC rate, overall survival and colostomy-free survival were 79%, 77% and 77%, respectively. Acute grade ≥3 toxicity occurred in 67.9% of the patients. Late grade 3 toxicity was seen in 16 patients (15.1%). Conclusions SIB-IMRT ± concurrent chemotherapy for anal cancer was effective with acceptable toxicity.
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Affiliation(s)
- Nathalie B. Tomasoa
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Didier Meulendijks
- Division of Clinical Pharmacology, Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jasper Nijkamp
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Annemieke Cats
- Division of Gastroenterology and Hepatology, Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Luc Dewit
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Abstract
Chemoradiotherapy is the standard-of-care treatment of squamous-cell carcinoma of the anus (SCCA), and this has not changed in decades. Radiation doses of 50-60 Gy, as used in many phase III trials, result in substantial late morbidities and fail to control larger and node-positive tumours. Technological advances in radiation therapy are improving patient outcomes and quality of life, and should be applied to patients with SCCA. Modern techniques such as intensity-modulated radiotherapy (IMRT), rotational IMRT, image-guided radiotherapy using cone-beam CT, and stereotactic techniques have enabled smaller margins and highly conformal plans, resulting in decreased radiation doses to the organs at risk and ensuring a shorter overall treatment time. In this Perspectives article, the use of novel approaches to target delineation, optimized radiotherapy techniques, adaptive radiotherapy, dose-escalation with external-beam radiotherapy (EBRT) or brachytherapy, and the potential for modified fractionation are discussed in the context of SCCA.
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What is the pelvic lymph node normal size? Determination from normal MRI examinations. Surg Radiol Anat 2015; 38:425-31. [DOI: 10.1007/s00276-015-1581-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 10/19/2015] [Indexed: 01/01/2023]
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Macchia G, Cilla S, Deodato F, Legge F, Di Stefano A, Chiantera V, Scambia G, Valentini V, Morganti AG, Ferrandina G. Intensity-modulated extended-field chemoradiation plus simultaneous integrated boost in the pre-operative treatment of locally advanced cervical cancer: a dose-escalation study. Br J Radiol 2015; 88:20150385. [PMID: 26388108 DOI: 10.1259/bjr.20150385] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the feasibility and determine the recommended pre-operative intensity-modulated radiotherapy (IMRT) dose of extended-field chemoradiation along with simultaneous integrated boost (SIB) dose escalation. METHODS A radiation dose of 40 Gy over 4 weeks, 2 Gy/fraction, was delivered to the tumour and the lymphatic drainage (planning target volume, PTV3), which encompassed a volume larger than standard (common iliac lymphatic area up to its apex, in front of the L3 vertebra), concurrently with chemotherapy (cisplatin and 5-fluorouracil). Radiation dose was escalated to the pelvis (PTV2) and to the macroscopic disease (PTV1) with the SIB-IMRT strategy. Three dose levels were planned: Level 1 (PTV3: 40/2 Gy; PTV2: 40/2 Gy; PTV1: 45/2.25 Gy), Level 2 (PTV3: 40/2 Gy; PTV2: 45/2.25 Gy; PTV1: 45/2.25 Gy) and Level 3 (PTV3: 40/2 Gy; PTV2: 45/2.25 Gy; PTV1: 50/2.5 Gy). All treatments were delivered in 20 fractions. Patients were treated in cohorts of between three and six per group using a Phase I study design. The recommended dose was exceeded if two of the six patients in a cohort experienced dose-limiting toxicity within 3 months from treatment. RESULTS 19 patients [median age: 46 years; The International Federation of Gynecology and Obstetrics (FIGO) stage IB2: 3, IIB: 10, IIIA-IIIB: 6] were enrolled. Median follow-up was 24 months (9-60 months). The most common grade 3/4 toxicity was gastrointestinal (GI) (diarrhoea, mucous discharge, rectal/abdominal pain). At Levels 1 and 2, only one grade 3 GI toxicity per level was recorded, whereas at Level 3, two grade 3 GI toxicities (diarrhoea, emesis and nausea) were recorded. CONCLUSION The SIB-IMRT technique was found to be feasible and safe at the recommended doses of 45 Gy to PTV1 and PTV2 and 40 Gy to PTV3 in the pre-operative treatment of patients with locally advanced cervical cancer. Unfortunately, this complex technique was unable to safely escalate dose beyond levels already achieved with three-dimensional conformal radiotherapy technique given acute GI toxicity. ADVANCES IN KNOWLEDGE A Phase I radiotherapy dose-escalation trial with SIB-IMRT technique is proposed in cervical cancer. This complex technique is feasible and safe at the recommended doses.
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Affiliation(s)
- Gabriella Macchia
- 1 Radiotherapy Unit, Department of Oncology, "John Paul II" Foundation, Catholic University, Campobasso, Italy
| | - Savino Cilla
- 2 Medical Physics Unit, "John Paul II" Foundation, Catholic University, Campobasso, Italy
| | - Francesco Deodato
- 1 Radiotherapy Unit, Department of Oncology, "John Paul II" Foundation, Catholic University, Campobasso, Italy
| | - Francesco Legge
- 3 Gynecologic Oncology Unit, Department of Oncology, "John Paul II" Foundation, Catholic University, Campobasso, Italy
| | - Aida Di Stefano
- 3 Gynecologic Oncology Unit, Department of Oncology, "John Paul II" Foundation, Catholic University, Campobasso, Italy
| | - Vito Chiantera
- 3 Gynecologic Oncology Unit, Department of Oncology, "John Paul II" Foundation, Catholic University, Campobasso, Italy
| | - Giovanni Scambia
- 4 Department of Obstetrics and Gynecology, "A. Gemelli" Hospital, Catholic University, Rome, Italy
| | - Vincenzo Valentini
- 5 Department of Radiotherapy, "A. Gemelli" Hospital, Catholic University, Rome, Italy
| | - Alessio G Morganti
- 6 Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine, DIMES University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Gabriella Ferrandina
- 4 Department of Obstetrics and Gynecology, "A. Gemelli" Hospital, Catholic University, Rome, Italy
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Kachlik D, Musil V, Baca V. Terminologia Anatomica after 17 years: Inconsistencies, mistakes and new proposals. Ann Anat 2015; 201:8-16. [DOI: 10.1016/j.aanat.2015.04.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 04/20/2015] [Accepted: 04/21/2015] [Indexed: 11/30/2022]
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Zikan M, Fischerova D, Pinkavova I, Slama J, Weinberger V, Dusek L, Cibula D. A prospective study examining the incidence of asymptomatic and symptomatic lymphoceles following lymphadenectomy in patients with gynecological cancer. Gynecol Oncol 2015; 137:291-8. [DOI: 10.1016/j.ygyno.2015.02.016] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 02/16/2015] [Indexed: 11/25/2022]
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White RD, Weir-McCall JR, Budak MJ, Waugh SA, Munnoch DA, Sudarshan TAP. Contrast-enhanced magnetic resonance lymphography in the assessment of lower limb lymphoedema. Clin Radiol 2014; 69:e435-44. [PMID: 25064763 DOI: 10.1016/j.crad.2014.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 06/03/2014] [Accepted: 06/09/2014] [Indexed: 10/25/2022]
Abstract
Chronic lower limb lymphoedema is a debilitating condition that may occur as a primary disorder or secondary to other conditions. Satisfactory visualization of the lymphatic vessels to aid diagnosis and surgical planning has been problematic. Historically, direct lymphography was used to visualize lymphatic vessels, although the significant surgical risks involved led to this being largely abandoned as a technique. Technetium-99m lymphoscintigraphy has been the mainstay of diagnosis for over two decades, but is hampered by inherently poor temporal and spatial resolution and limited anatomical detail. Contrast-enhanced magnetic resonance lymphography (MRL) is a relatively new technique that shows early promise in the evaluation of chronic lymphoedema. This article provides the procedural technique for lower limb MRL at both 1.5 and 3 T, discusses pathophysiology and classifications of lymphoedema, provides an overview of relevant lower limb lymphatic anatomy using MRL imaging, compares the various techniques used in the diagnosis of lower limb lymphoedema, shows common pathological MRL imaging findings, and describes alternative uses of MRL. Utilization of this technique will allow more accurate diagnosis and classification of patients suffering from lymphoedema.
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Affiliation(s)
- R D White
- Department of Clinical Radiology, Ninewells Hospital and Medical School, Ninewells Avenue, Dundee DD1 9SY, UK; Department of Clinical Radiology, University Hospital of Wales, Cardiff CF14 4XW, UK
| | - J R Weir-McCall
- Department of Clinical Radiology, Ninewells Hospital and Medical School, Ninewells Avenue, Dundee DD1 9SY, UK
| | - M J Budak
- Department of Clinical Radiology, Ninewells Hospital and Medical School, Ninewells Avenue, Dundee DD1 9SY, UK
| | - S A Waugh
- Department of Clinical Radiology, Ninewells Hospital and Medical School, Ninewells Avenue, Dundee DD1 9SY, UK
| | - D A Munnoch
- Department of Plastic Surgery, Ninewells Hospital and Medical School, Ninewells Avenue, Dundee DD1 9SY, UK
| | - T A P Sudarshan
- Department of Clinical Radiology, Ninewells Hospital and Medical School, Ninewells Avenue, Dundee DD1 9SY, UK.
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Scher ED, Ahmed I, Yue NJ, Jabbour SK. Technical aspects of radiation therapy for anal cancer. J Gastrointest Oncol 2014; 5:198-211. [PMID: 24982768 DOI: 10.3978/j.issn.2078-6891.2014.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 05/22/2014] [Indexed: 01/26/2023] Open
Abstract
Historically treated with surgery, current practice recommends anal carcinoma to be treated with a combination of chemotherapy and radiation. This review will examine the anatomy, modes of disease spread and recurrence, and evaluate the existing evidence for treatment options for these tumors. An in-depth examination of specific radiation therapy (RT) techniques-such as conventional 3D-conformal RT and intensity-modulated RT-will be discussed along with modern dose constraints. RT field arrangement, patient setup, and recommended gross and clinical target volume (CTV) contours will be considered. Areas in need of further investigation, such as the role in treatment for positron emission tomography (PET) will be explored.
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Affiliation(s)
- Eli D Scher
- 1 Rowan University School of Osteopathic Medicine, Stratford, NJ 08084, USA ; 2 Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ 08903, USA
| | - Inaya Ahmed
- 1 Rowan University School of Osteopathic Medicine, Stratford, NJ 08084, USA ; 2 Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ 08903, USA
| | - Ning J Yue
- 1 Rowan University School of Osteopathic Medicine, Stratford, NJ 08084, USA ; 2 Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ 08903, USA
| | - Salma K Jabbour
- 1 Rowan University School of Osteopathic Medicine, Stratford, NJ 08084, USA ; 2 Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ 08903, USA
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Matsumoto N, Uehara K, Ando M, Arimoto J, Kato T, Nakamura H, Ebata T, Yokoyama Y, Nagino M. Adenocarcinoma arising from sacrococcygeal mature teratoma in an adult female: report of a case. Front Oncol 2014; 4:117. [PMID: 24904830 PMCID: PMC4032893 DOI: 10.3389/fonc.2014.00117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 05/06/2014] [Indexed: 11/13/2022] Open
Abstract
We report a case of adenocarcinoma arising from a sacrococcygeal mature teratoma in an adult female. A 62-year-old female was diagnosed with a presacral tumor 10 years ago. Pelvic computed tomography (CT) demonstrated a presacral heterogeneous tumor, containing multiloculated cystic area and enhanced solid component with calcification. Percutaneous needle biopsy for the solid component of the tumor identified an adenocarcinoma and the patient was diagnosed as having a sacrococcygeal teratoma with malignant transformation. Abdomino-sacral rectal resection with sacral amputation at the upper edge of the S5 was performed. The pathological diagnosis was adenocarcinoma derived from a mature teratoma. The tumor cells had infiltrated the rectal wall. After 7 months, a follow-up CT demonstrated swelling of the right inguinal lymph nodes and a right inguinal lymphadenectomy was performed. Pathological examination showed metastatic lymph nodes. The patient is doing well 21 months after the second surgery, with no signs of recurrence.
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Affiliation(s)
- Naoki Matsumoto
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Keisuke Uehara
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Masataka Ando
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Junki Arimoto
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Takehiro Kato
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Hayato Nakamura
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Tomoki Ebata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Yukihiro Yokoyama
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Masato Nagino
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine , Nagoya , Japan
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Pattern of occult nodal relapse diagnosed with 18F-fluoro-choline PET/CT in prostate cancer patients with biochemical failure after prostate-only radiotherapy. Radiother Oncol 2014; 111:120-5. [DOI: 10.1016/j.radonc.2014.03.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 02/21/2014] [Accepted: 03/02/2014] [Indexed: 11/21/2022]
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37
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Délinéation des volumes cibles anatomocliniques pour la radiothérapie des cancers du col utérin. Cancer Radiother 2013; 17:486-92. [DOI: 10.1016/j.canrad.2013.06.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 06/05/2013] [Indexed: 11/19/2022]
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Kasuya G, Toita T, Furutani K, Kodaira T, Ohno T, Kaneyasu Y, Yoshimura R, Uno T, Yogi A, Ishikura S, Hiraoka M. Distribution patterns of metastatic pelvic lymph nodes assessed by CT/MRI in patients with uterine cervical cancer. Radiat Oncol 2013; 8:139. [PMID: 23758698 PMCID: PMC3682904 DOI: 10.1186/1748-717x-8-139] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 06/01/2013] [Indexed: 11/14/2022] Open
Abstract
Background To investigate the three-dimensional (3D) distribution patterns of clinically metastatic (positive) lymph nodes on pretreatment computed tomography (CT)/magnetic resonance imaging (MRI) images of patients with locally advanced cervical cancer. Methods We enrolled 114 patients with uterine cervical cancer with positive nodes by CT/MRI (≥10 mm in the shortest diameter). Pretreatment CT/MRI data were collected at 6 institutions. The FIGO stage was IB1 in 2 patients (2%), IB2 in 6 (5%), IIA in 3 (3%), IIB in 49 (43%), IIIB in 50 (44%), and IVA in 4 (4%) patients. The median cervical tumor diameter assessed by T2-weighted MRI was 55 mm (range, 10–87 mm). The anatomical distribution of the positive nodes was evaluated on CT/MRI images by two radiation oncologists and one diagnostic radiologist. Results In these patients, 273 enlarged nodes were assessed as positive. The incidence of positive nodes was 104/114 (91%) for the obturator region, 31/114 (27%) for the external iliac region, 16/114 (14%) for the internal iliac region, 22/114 (19%) for the common iliac region, and 6/114 (5%) for the presacral region. The external iliac region was subdivided into four sub-regions: lateral, intermediate, medial, and caudal. The obturator region was subdivided into two sub-regions: cranial and caudal. The majority of patients had positive nodes in the cranial obturator and/or the medial external iliac region (111/114). In contrast, few had positive nodes in the lateral external iliac, caudal external iliac, caudal obturator, internal iliac and presacral regions. All cases with positive nodes in those low-risk regions also had positive nodes in other pelvic nodal regions concomitantly. The incidence of positive nodes in the low-risk regions/sub-regions was significantly related to FIGO stage (p=0.017) and number of positive nodes (p<0.001). Conclusions We demonstrated the 3D distribution patterns of clinical metastatic pelvic lymph nodes on pretreatment CT/MRI images of patients with locally advanced cervical cancer. These findings might contribute to future individualization of the clinical target volume of the pelvic nodes in patients with cervical cancer.
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Affiliation(s)
- Goro Kasuya
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan.
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Deenen MJ, Dewit L, Boot H, Beijnen JH, Schellens JHM, Cats A. Simultaneous integrated boost-intensity modulated radiation therapy with concomitant capecitabine and mitomycin C for locally advanced anal carcinoma: a phase 1 study. Int J Radiat Oncol Biol Phys 2013; 85:e201-7. [PMID: 23517808 DOI: 10.1016/j.ijrobp.2012.12.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 12/07/2012] [Accepted: 12/09/2012] [Indexed: 12/17/2022]
Abstract
PURPOSE Newer radiation techniques, and the application of continuous 5-FU exposure during radiation therapy using oral capecitabine may improve the treatment of anal cancer. This phase 1, dose-finding study assessed the feasibility and efficacy of simultaneous integrated boost-intensity modulated radiation therapy (SIB-IMRT) with concomitant capecitabine and mitomycin C in locally advanced anal cancer, including pharmacokinetic and pharmacogenetic analyses. METHODS AND MATERIALS Patients with locally advanced anal carcinoma were treated with SIB-IMRT in 33 daily fractions of 1.8 Gy to the primary tumor and macroscopically involved lymph nodes and 33 fractions of 1.5 Gy electively to the bilateral iliac and inguinal lymph node areas. Patients received a sequential radiation boost dose of 3 × 1.8 Gy on macroscopic residual tumor if this was still present in week 5 of treatment. Mitomycin C 10 mg/m(2) (maximum 15 mg) was administered intravenously on day 1, and capecitabine was given orally in a dose-escalated fashion (500-825 mg/m(2) b.i.d.) on irradiation days, until dose-limiting toxicity emerged in ≥2 of maximally 6 patients. An additional 8 patients were treated at the maximum tolerated dose (MTD). RESULTS A total of 18 patients were included. The MTD of capecitabine was determined to be 825 mg/m(2) b.i.d. The predominant acute grade ≥3 toxicities included radiation dermatitis (50%), fatigue (22%), and pain (6%). Fifteen patients (83% [95%-CI: 66%-101%]) achieved a complete response, and 3 (17%) patients a partial response. With a median follow-up of 28 months, none of the complete responders, and 2 partial responders had relapsed. CONCLUSIONS SIB-IMRT with concomitant single dose mitomycin C and capecitabine 825 mg/m(2) b.i.d. on irradiation days resulted in an acceptable safety profile, and proved to be a tolerable and effective treatment regimen for locally advanced anal cancer.
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Affiliation(s)
- Maarten J Deenen
- Division of Clinical Pharmacology, Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Bats AS, Nos C, Bensaïd C, Le Frère-Belda MA, Collignon MA, Faraggi M, Lécuru F. Lower-limb drainage mapping for lymphedema risk reduction after pelvic lymphadenectomy for endometrial cancer. Oncologist 2013; 18:174-9. [PMID: 23335621 DOI: 10.1634/theoncologist.2012-0309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Pelvic lymphadenectomy is associated with a significant risk of lower-limb lymphedema. In this proof-of-concept study, we evaluated the feasibility of identifying the lower-limb drainage nodes (LLDNs) during pelvic lymphadenectomy for endometrial cancer. Secondary objectives were to map lower-limb drainage and to assess the diagnostic value of our mapping technique. METHODS This prospective study included patients with endometrial cancer requiring pelvic lymphadenectomy, without neoadjuvant radiotherapy or chemotherapy and without history of lower-limb surgery. A radiopharmaceutical was injected into both feet on the day before surgery. LLDNs were identified using preoperative lymphoscintigraphy and intraoperative isotopic probe detection, then removed before complete pelvic lymphadenectomy. LLDNs and pelvic lymphadenectomy specimens underwent separate histological analysis. RESULTS Of the 12 patients with early-stage endometrial cancer, 10 underwent preoperative lymphoscintigraphy, which consistently identified inguinal, femoral, and pelvic LLDNs (detection rate: 100%). The intraoperative detection rate was 83% (10/12). Median number of hot nodes per patient was 5 nodes (range: 3-7) on the right and 3 nodes (range: 2-6) on the left. Of 107 LLDNs, 106 were in the external iliac area, including 38 in the lateral group and 45 in the intermediate and medial groups. None of the patients had node metastases at any site. No early complications related to the technique occurred. CONCLUSION Our mapping technique appears feasible, safe, and associated with a high LLDN identification rate. LLDN mapping may allow the preservation of LLDNs, thereby decreasing the risk of lower-limb lymphedema and improving quality of life.
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Affiliation(s)
- Anne-Sophie Bats
- Department of Medicine, INSERM UMR-S 747, Université Paris Descartes, Faculté de Médecine, Sorbonne Paris Cité, Paris, France.
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Meijer HJM, Fortuin AS, van Lin ENJT, Debats OA, Alfred Witjes J, Kaanders JHAM, Barentsz JO. Geographical distribution of lymph node metastases on MR lymphography in prostate cancer patients. Radiother Oncol 2012. [PMID: 23199653 DOI: 10.1016/j.radonc.2012.10.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate the pattern of lymph node spread on magnetic resonance lymphography (MRL) in prostate cancer patients and compare this pattern to the clinical target volume for elective pelvis irradiation as defined by the radiation therapy oncology group (RTOG-CTV). METHODS AND MATERIALS The charts of 60 intermediate and high risk prostate cancer patients with non-enlarged positive lymph nodes on MRL were reviewed. Positive lymph nodes were assigned to a lymph node region according to the guidelines for delineation of the RTOG-CTV. Five lymph node regions outside this RTOG-CTV were defined: the para-aortal, proximal common iliac, pararectal, paravesical and inguinal region. RESULTS Fifty-three percent of the patients had an MRL-positive lymph node in a lymph node region outside the RTOG-CTV. The most frequently involved aberrant sites were the proximal common iliac, the pararectal and para-aortal region, which were affected in 30%, 25% and 18% respectively. CONCLUSION More than half of the patients had an MRL-positive lymph node outside the RTOG-CTV. To reduce geographical miss while minimizing the toxicity of radiotherapy, image based definition of an individual target volume seems to be necessary.
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Affiliation(s)
- Hanneke J M Meijer
- Department of Radiation Oncology, Radbound University Nijmegen, Medical Centre, Nijmegen, The Netherlands.
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Knäusl B, Lütgendorf-Caucig C, Hopfgartner J, Dieckmann K, Kurch L, Pelz T, Pötter R, Georg D. Can treatment of pediatric Hodgkin’s lymphoma be improved by PET imaging and proton therapy? Strahlenther Onkol 2012; 189:54-61. [DOI: 10.1007/s00066-012-0235-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 09/17/2012] [Indexed: 01/16/2023]
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Kim CH, Olson AC, Kim H, Beriwal S. Contouring inguinal and femoral nodes; how much margin is needed around the vessels? Pract Radiat Oncol 2012; 2:274-278. [DOI: 10.1016/j.prro.2011.12.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 12/19/2011] [Indexed: 11/27/2022]
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Hoskin PJ, Díez P, Williams M, Lucraft H, Bayne M. Recommendations for the use of radiotherapy in nodal lymphoma. Clin Oncol (R Coll Radiol) 2012; 25:49-58. [PMID: 22889569 DOI: 10.1016/j.clon.2012.07.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 05/22/2012] [Accepted: 05/29/2012] [Indexed: 12/25/2022]
Abstract
These guidelines have been developed to define the use of radiotherapy for lymphoma in the current era of combined modality treatment taking into account increasing concern over the late side-effects associated with previous radiotherapy. The role of reduced volume and reduced doses is addressed, integrating modern imaging with three-dimensional planning and advanced techniques of treatment delivery. Both wide-field and involved-field techniques have now been supplanted by the use of defined volumes based on node involvement shown on computed tomography (CT) and positron emission tomography (PET) imaging and applying the International Commission on Radiation Units and Measurements concepts of gross tumour volume (GTV), clinical target volume (CTV) and planning target volume (PTV). The planning of lymphoma patients for radical radiotherapy should now be based upon contrast enhanced 3 mm contiguous CT with three-dimensional definition of volumes using the convention of GTV, CTV and PTV. The involved-site radiotherapy concept defines the CTV based on the PET-defined pre-chemotherapy sites of involvement with an expansion in the cranio-caudal direction of lymphatic spread by 1.5 cm, constrained to tissue planes such as bone, muscle and air cavities. The margin allows for uncertainties in PET resolution, image registration and changes in patient positioning and shape. There is increasing evidence in both Hodgkin and non-Hodgkin lymphoma that traditional doses are higher than necessary for disease control and related to the incidence of late effects. No more than 30 Gy for Hodgkin and aggressive non-Hodgkin lymphoma and 24 Gy for indolent lymphomas is recommended; lower doses of 20 Gy in combination therapy for early-stage low-risk Hodgkin lymphoma may be sufficient. As yet there are no large datasets validating the use of involved-site radiotherapy; these will emerge from the current generation of clinical trials. Radiotherapy remains the most effective single modality in the treatment of lymphoma. A reduction in both treatment volume and overall treatment dose should now be considered to minimise the risks of late sequelae. However, it is important that this is not at the expense of the excellent disease control currently achieved.
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Affiliation(s)
- P J Hoskin
- Mount Vernon Cancer Centre, Northwood, Middlesex, UK.
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Concomitant boost plus large-field preoperative chemoradiation in locally advanced uterine cervix carcinoma: Phase II clinical trial final results (LARA-CC-1). Gynecol Oncol 2012; 125:594-9. [DOI: 10.1016/j.ygyno.2012.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 03/05/2012] [Accepted: 03/05/2012] [Indexed: 11/19/2022]
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Abstract
A 78-year-old female with locally recurrent rectal carcinoma and hepatic metastases presented with new skin lesions. She had multiple painful skin lesions over her groin area initially treated as contact dermatitis. The lesions continued to spread to include the lower abdomen and developed a zosteriform appearance. She was referred to dermatology, where shave biopsies revealed metastatic rectal carcinoma. This case is unique as the patient had rapidly growing zosteriform cutaneous metastases from rectal carcinoma, which has rarely been reported. Physicians providing care to patients with a history of cancer should maintain a high clinical suspicion for cutaneous metastases in patients with new or evolving skin conditions.
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Abstract
Tumors of the anus and perianal skin are rare. Their presentation can vary and often mimics common benign anal pathology, thereby delaying diagnosis and appropriate and timely treatment. The anatomy of this region is complex because it represents the progressive transition from the digestive system to the skin with many different co-existing types of cells and tissues. Squamous cell carcinoma of the anal canal is the most frequent tumor found in the anal and perianal region. Less-frequent lesions include Bowen's and Paget's disease, basal cell carcinoma, melanoma, and adenocarcinoma. This article aims to review the clinical presentation, diagnostic evaluation, and treatment options for neoplasms of the anal canal and perianal skin.
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Affiliation(s)
- Daniel Leonard
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota
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Matthews JHL, Burmeister BH, Borg M, Capp AL, Joseph D, Thompson KM, Thompson PI, Harvey JA, Spry NA. T1-2 anal carcinoma requires elective inguinal radiation treatment--the results of Trans Tasman Radiation Oncology Group study TROG 99.02. Radiother Oncol 2010; 98:93-8. [PMID: 21109321 DOI: 10.1016/j.radonc.2010.10.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 09/27/2010] [Accepted: 10/03/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND PURPOSE Elective inguinal irradiation increases morbidity. We describe outcomes of moderate intensity chemoradiation treating anal canal and adjacent pelvic nodes only. MATERIAL AND METHODS Forty patients with T1-2, N0 anal carcinoma were enrolled between March 1999 and March 2003. Inguinal nodes were NOT electively irradiated. The anal canal and regional pelvic nodes received 36 Gy/20# over 4 weeks, and 2 weeks later the anal canal was boosted with 14.4 Gy/8#. Chemotherapy was 5 fluorouracil 800 mg/m(2)/day on days 1-4 and 36-39, and Mitomycin C 10mg/m(2) on day 1. RESULTS Median follow-up was 44 months. Complete response was 95%. Four year results were; overall survival 71%, local control 82%, and colostomy-free survival (including salvage) 85%. Inguinal failure occurred in 22.5% but was isolated in only 12.5%. Treatment was well tolerated acutely with no toxic deaths. Severe late toxicity occurred in 7.5%. CONCLUSIONS This moderate dose 'non inguinal' chemoradiation regimen resulted in modest acute toxicity, minimal long term morbidity and local control in line with other series. However staging failed to identify 12.5% of patients whose isolated inguinal failure might have been prevented by elective irradiation. Without more effective staging, all patients should receive elective inguinal irradiation.
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Affiliation(s)
- John H L Matthews
- Department of Radiation Oncology, Auckland City Hospital, New Zealand.
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Macchia G, Ferrandina G, Deodato F, Ruggieri V, Massaccesi M, Salutari V, Valentini V, Cellini N, Scambia G, Morganti AG. Concomitant boost dose escalation plus large-field preoperative chemoradiation in locally advanced carcinoma of the uterine cervix: Results of a phase I study (LARA-CC-1). Gynecol Oncol 2010; 118:128-33. [DOI: 10.1016/j.ygyno.2010.04.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 04/20/2010] [Accepted: 04/24/2010] [Indexed: 11/30/2022]
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Current world literature. Curr Opin Otolaryngol Head Neck Surg 2010; 18:134-45. [PMID: 20234215 DOI: 10.1097/moo.0b013e3283383ef9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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