Lymph flow guided irradiation of regional lymph nodes in patients with cervical cancer: Preliminary analysis of scintigraphic data

Abstract

To evaluate patterns of lymph flow from primary lesions in patients with cervical cancer and to determine how useful for radiotherapy planning this information can be. Materials and methods: SPECT-CT visualization of sentinel (SLN) lymph nodes (LNs) was performed in 36 primary patients with IB-IIB cervical cancer. The acquisition started 120-240 min after 4 peritumoral injections of 99mTc-radiocolloids (150-300 MBq in 0.4-1 ml). We determined localization of LN with uptake of radiocolloids, type of lymph flow (mono-, bilateral) and lymph flow patterns (supraureteral paracervical, infraureteral paracervical and directly to para-aortic LNs). Results: SLNs were visualized in 31 of 36 women. Bilateral lymph-flow was detected in 22 (71%), monolateral-in the other 9 (29%) cases. The distribution of SLNs was as follows: external iliac-64.5%, internal iliac-54.8%, obturator-32.2%, common iliac-35.5% and pre-sacral 3.2%. Para-aortic LNs were visualized in 5 (16.1%) patients. The supraureteral paracervical pattern of lymph flow was identified in 22, infraureteral paracervical-in 4 and their combination-in the other 5 women. Conclusion: Visualization of an individual pattern of lymph flow from primary cervical cancer can be considered as a promising tool for optimization of the volume of irradiated regional LNs.

New developments and controversies in cervical cancer

“…6 Indeed, magnetic resonance imaging (MRI) is now considered the gold standard for volume definition in planning both EBRT and brachytherapy; in this regard, this special issue includes two papers that describe the imaging techniques for treatment planning in patients with CC. 7,8 At present, MRI and PET-CT are considered the best imaging tools for patient follow-up. Moreover, pre-and post-treatment imaging data obtained via MRI and PET-CT can provide valuable information-together with molecular markers-to better establish prognosis and predict treatment outcomes.…”

Single photon emission computed tomography-computed tomography visualization of sentinel lymph nodes for lymph flow guided nodal irradiation in oral tongue cancer

“…The main idea of this concept is based on the assumption of the sequential and predictable manner of lymph flow from the tumor to the regional LNs, and hence on predictable order of LNs metastatic involvement [ 9 ]. The logical evolution of these ideas led to the concept of lymph flow guided radiotherapy already discussed in patients with breast, prostate, head and neck, and cervical cancer [ 10 - 13 ]. The main purpose of the present study was to evaluate the correlation of single photon emission computed tomography-computed tomography (SPECT-CT) data on lymph flow from oral tongue cancer and the topography of LNs metastases revealed with histological examinations and during the follow-up.…”

Spect-Ct Visualization of Sentinel Lymph Nodes and Lymph Flow From Tongue Cancer

“…Согласно указанной радиотерапевтической стратегии перед планированием лучевого лечения у онкологических больных проводится визуализация путей лимфооттока от первичной опухоли и, в последующем, осуществляется облучение только сигнальных лимфоузлов и лимфоузлов 2 порядка, которые находятся на пути лимфооттока и регионарного метастазирования [2,13]. В настоящее время имеются сообщения об использовании данных радионуклидной визуализации путей лимфооттока от первичной опухоли при определении топографии радиационных полей у больных раком молочной железы, предстательной железы, раком шейки матки [1,3,13,21]. рядом авторов [8,10,20] было высказано предположение, что указанные подходы могут быть использованы при планировании лучевой терапии у больных злокачественными новообразованиями головы и шеи.…”