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Inamdar A, Shinde RK. The Diagnostic Impact of Contrast-Enhanced Computed Tomography (CECT) in Evaluating Lymph Node Involvement in Colorectal Cancer: A Comprehensive Review. Cureus 2024; 16:e61832. [PMID: 38975400 PMCID: PMC11227440 DOI: 10.7759/cureus.61832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Accepted: 06/03/2024] [Indexed: 07/09/2024] Open
Abstract
Colorectal cancer (CRC) remains a significant global health burden, necessitating accurate staging and treatment planning for optimal patient outcomes. Lymph node involvement is a critical determinant of prognosis in CRC, emphasizing the importance of reliable imaging techniques for its evaluation. Contrast-enhanced computed tomography (CECT) has emerged as a cornerstone in CRC imaging, offering high-resolution anatomical detail and vascular assessment. This comprehensive review synthesizes the existing literature to evaluate the diagnostic impact of CECT in assessing lymph node involvement in CRC. Key findings highlight CECT's high sensitivity and specificity in detecting lymph node metastases, facilitating accurate staging and treatment selection. However, challenges such as limited resolution for small lymph nodes and potential false-positives call for a cautious interpretation. Recommendations for clinical practice suggest the integration of CECT into multidisciplinary treatment algorithms, optimizing imaging protocols and enhancing collaboration between radiologists and clinicians. Future research directions include refining imaging protocols, comparative effectiveness studies with emerging modalities, and prospective validation of CECT's prognostic value. Overall, this review stresses the pivotal role of CECT in CRC management and identifies avenues for further advancements in imaging-guided oncology care.
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Affiliation(s)
- Akash Inamdar
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Raju K Shinde
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Thaper D, Yadav HP, Sharma D, Kamal R, Singh G, Oinam AS, Kumar V. Degree of reduction in normal liver complication probability from free-breathing to breath-hold liver SBRT: a dose-escalation strategy using radiation dose-volume effect. Biomed Phys Eng Express 2021; 8. [PMID: 34874286 DOI: 10.1088/2057-1976/ac3fe5] [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: 11/16/2021] [Accepted: 12/03/2021] [Indexed: 11/12/2022]
Abstract
Introduction. This study aimed to analyze the degree of reduction in normal liver complication probability (NTCP) from free-breathing (FB) to breath-hold (BH) liver SBRT. The effect of the radiation dose-volume on the mean liver dose (MLD) was also analyzed due to dose prescription, normal liver volume (NLV), and PTV.Materials and Methods. Thirty-three stereotactic body radiation therapy (SBRT) cases of hepatocellular carcinoma were selected, retrospectively. For FB, the treatments were planned on average intensity projection scan (CTavg), and patient-specific internal target volume (ITV) margins were applied. To simulate the BH treatment, computed tomography (CT) scan correspond to the 40%-50% of the respiratory cycle (CT40%-50%) was chosen, and an appropriate intrafraction margin of 2 mm, 1.5 mm, and 1.5 mm were given in craniocaudal (CC), superior-inferior (SI), and lateral direction to generate the final iGTV. As per RTOG 1112, all organs at risk (OAR's) were considered during the optimization of treatment plans. NTCP was calculated using LKB fractionated model. Multivariate regression analysis was performed to see the effect of EQD2Gy, NLV, and PTV on MLD2Gy.Results.A significant dosimetric difference was observed in the normal liver (liver-ITV/iGTV). A reduction of 1.7% in NTCP was observed from FB to BH technique. The leverage of dose escalation is more in BH because MLD2Gycorresponds to 5%, 10%, 20%, and 50% NTCP was 0.099 Gy, 0.41 Gy, 1.21 Gy, and 3.432 Gy more in BH as compared to FB technique. In MVRA, the major factor which was attributed to a change in MLD2Gyis EQD2Gy. Conclusion. From FB to BH technique, a significant reduction in NTCP was observed. The dose prescription is a major factor attributed to the change in MLD2Gy. Advances in knowledge: If feasible, prefer BH treatment either for tumor dose escalation or for the reduction in NTCP.
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Affiliation(s)
- Deepak Thaper
- Centre for Medical Physics, Panjab University, Chandigarh, India.,Radiation Oncology Department, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Hanuman P Yadav
- Radiation Oncology Department, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Deepti Sharma
- Radiation Oncology Department, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Rose Kamal
- Centre for Medical Physics, Panjab University, Chandigarh, India.,Radiation Oncology Department, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Gaganpreet Singh
- Centre for Medical Physics, Panjab University, Chandigarh, India.,Radiotherapy Department, PGIMER, Regional Cancer Centre, Chandigarh, India
| | - Arun S Oinam
- Radiotherapy Department, PGIMER, Regional Cancer Centre, Chandigarh, India
| | - Vivek Kumar
- Centre for Medical Physics, Panjab University, Chandigarh, India
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