Radiologic Assessment of Lymph Nodes in Oncologic Patients

Mao, Yun; Hedgire, Sandeep; Harisinghani, Mukesh G.

doi:10.1007/s40134-013-0036-6

Cited by 36 publications

(30 citation statements)

References 70 publications

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“…To evaluate the treatment response, to avoid continuing chemotherapy if the patient is not responding, or to change the planned treatment if the disease progresses, upper abdomen and chest CT should be used for distance disease assessment during or after neoadjuvant chemotherapy (consensus, LE: 5). MRI or pelvic CT is the most suitable imaging modality for loco-regional response evaluation of neoadjuvant chemotherapy (recommendation, LE: 5), as it can show deep lymph nodes and masses in the pelvis and retroperitoneum (Mao et al 2014 ).…”

Section: Resultsmentioning

confidence: 99%

Penile cancer: a Brazilian consensus statement for low- and middle-income countries

Soares

Carvalho

Fonseca³

et al. 2020

J Cancer Res Clin Oncol

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Purpose Penile cancer is highly prevalent in low- and middle-income countries, with significant morbidity and mortality rates. The first Brazilian consensus provides support to improve penile cancer patients’ outcomes, based on expert’s opinion and evidence from medical literature. Methods Fifty-one Brazilian experts (clinical oncologists, radiation oncologists, urologists, and pathologists) assembled and voted 104 multiple-choice questions, confronted the results with the literature, and ranked the levels of evidence. Results Healthcare professionals need to deliver more effective communication about the risk factors for penile cancer. Staging and follow-up of patients include physical examination, computed tomography, and magnetic resonance imaging. Close monitoring is crucial, because most recurrences occur in the first 2–5 years. Lymph-node involvement is the most important predictive factor for survival, and management depends on the location (inguinal or pelvic) and the number of lymph nodes involved. Conservative treatment may be helpful in selected patients without compromising oncological outcomes; however, surgery yields the lowest rate of local recurrence. Conclusion This consensus provides an essential decision-making orientation regarding this challenging disease.

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Section: Resultsmentioning

confidence: 99%

Penile cancer: a Brazilian consensus statement for low- and middle-income countries

Soares

Carvalho

Fonseca³

et al. 2020

J Cancer Res Clin Oncol

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“…Lymph nodes were classified preoperatively as suspicious according to the original RECIST 1.1 criteria, the RECIST 1.1 amendment specifically designed for lymph node assessment and further supporting literature [21,22]. Criteria applied to determine malignancy were first and foremost the size with a short-axis diameter > 1.5 cm but also further ancillary imaging features such as spherical shape, no fatty hilus, strong contrast enhancement, MR-diffusion restriction, central necrosis, threshold growth and distribution pattern [23]. Examined lymph node stations were the hepatoduodenal ligament, retropancreatic, the lesser curvature, interaortocaval, and superior to the diaphragm.…”

Section: Preoperative Evaluation and Imagingmentioning

confidence: 99%

Relevance of suspicious lymph nodes in preoperative imaging for resectability, recurrence and survival of intrahepatic cholangiocarcinoma

et al. 2020

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Background: Intrahepatic cholangiocarcinoma (ICC) is often diagnosed at an advanced stage resulting in a low resectability rate. Even after potentially curative resection the risk for tumor recurrence is high. Although the extent and value of lymphadenectomy is part of ongoing discussion, the role of preoperative imaging for assessment of suspicious lymph nodes (suspLN) has only been studied modestly. Aim of this study is to demonstrate the influence of suspicious lymph nodes in preoperative imaging on resectability, recurrence, and long-term outcome.Methods: All patients who underwent exploration for ICC between January 2008 and June 2018 were included. Preoperative imaging (CT or MRI) was analysed with focus on suspLN at the hepatoduodenal ligament, lesser curvature, interaortocaval, and superior to the diaphragm; suspLN were classified according to the universally accepted RECIST 1.1 criteria; histopathology served as gold standard.Results: Out of 187 patients resection was performed in 137 (73.3%), in 50 patients the procedure was terminated after exploration. Overall, suspLN were found preoperatively in 73/187 patients (39%). Comparing patients who underwent resection and exploration only, suspLN were significantly more common in the exploration group (p = 0.011). Regarding lymph node stations, significant differences could be shown regarding resectability: All tumors with suspLN superior to the diaphragm were irresectable. Preoperative imaging assessment showed a strong correlation with final histopathology, especially of suspLN of the hepatoduodenal ligament and the lesser curvature. Sensitivity of suspLN was 71.1%, specificity 90.8%. Appearance of tumor recurrence was not affected by suspLN (p = 0.289). Using a short-axis cut-off of <> 1 cm, suspLN had significant influence on recurrence-free survival (RFS, p = 0.009) with consecutive 1-, 3-, and 5-year RFS of 41, 21, and 15% versus 29, 0, and 0%, respectively. Similarly, 1-, 3-and 5-year overall survival (OS) was 75, 30, and 18% versus 59, 18, and 6%, respectively (p = 0.040).

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“…Finally, there was heterogeneity with respect to the radiation dose delivered over this 10-year period, and it is possible that rates of regional lymph node recurrence are underestimated in this study due to limitations in sensitivity of currently available imaging modalities. 22 The strengths of this study include a comprehensive assessment of patterns of failure and real-world outcomes of cholangiocarcinoma patients treated with SBRT. Our findings compare favorably to previously published series.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic Body Radiation Therapy for Cholangiocarcinoma: Optimizing Locoregional Control With Elective Nodal Irradiation

Kozak

Toesca

Eyben

et al. 2020

Advances in Radiation Oncology

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To review our institutional experience of treating cholangiocarcinoma using stereotactic body radiation therapy (SBRT). Methods and Materials: A total of 40 patients with intrahepatic (n Z 25) or perihilar (n Z 15) cholangiocarcinoma treated with SBRT were retrospectively reviewed. SBRT was delivered in 1 to 5 fractions with median dose of 40 Gy. Competing risk analysis was used to estimate cumulative incidence of local in-field, local out-of-field, regional, and distant failure. Kaplan-Meier and log-rank tests were used to calculate overall survival (OS). Toxicity was scored using Common Terminology Criteria for Adverse Events, version 4.0. Results: The median follow-up time was 18 months. The 1-year incidence of local in-field, local out-of-field, regional, and distant failure was 8%, 23%, 13%, and 22%, respectively. Median OS was 23 months and 1-and 2-year OS rates were 69% and 39%, respectively. Patients with perihilar tumors had a 1-year incidence of regional failure of 24% and worse OS (P Z .013). Patients with regional failure were more likely to develop distant metastases, 32% versus 19% at 1 year (P Z .11). Acute grade 3 þ hepatobiliary toxicity developed in 15 patients (36%). Conclusions: In this series of cholangiocarcinoma patients treated with definitive SBRT, patterns of failure reveal that regional failures are not insignificant, particularly for perihilar tumors. Elective nodal irradiation of regional lymphatics should be considered when using SBRT. A prospective study of elective nodal irradiation in patients with perihilar tumors would further clarify whether this approach improves outcomes without increasing hepatobiliary toxicity.

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Radiologic Assessment of Lymph Nodes in Oncologic Patients

Cited by 36 publications

References 70 publications

Penile cancer: a Brazilian consensus statement for low- and middle-income countries

Penile cancer: a Brazilian consensus statement for low- and middle-income countries

Relevance of suspicious lymph nodes in preoperative imaging for resectability, recurrence and survival of intrahepatic cholangiocarcinoma

Stereotactic Body Radiation Therapy for Cholangiocarcinoma: Optimizing Locoregional Control With Elective Nodal Irradiation

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