1053: Distribution of Sentinel Lymph Nodes in Patients With Cervical Cancer- Implications for Target Volumes in Radiation Therapy?

Abstract

BackgroundThere are only limited data regarding the mapping of the removed sentinel lymph nodes (SLN). A correlation between the localization of SLN and the tumor stage, histology or marker substance has never been investigated.Purpose/Objective(s)We investigated whether the distribution of SLN would have an impact on radiation target volumes.Materials/MethodsBetween 2/2000 and 6/2005 the SLN distribution of 151 patients with histologically confirmed cervical cancer (FIGO stages IA n= 21, IB n=95, IIA n=14, IIB n=18, IIIB n=2, IVA n=1), who participated in the ongoing “Uterus 3” sentinel study of the German Association of Gynecologic Oncologists (AGO), were retrospectively analysed with respect to the histology, tumor stage and detection substance. The tumors comprised mostly squamous cell carcinomas (75.5%) with a smaller fraction of adenocarcinomas (24.5%).ResultsAltogether 406 SLN, an average of 2.7 (1-7) SLN per patient, were removed. More than one SLN was detected in 111 patients (73.5%). SLN sites were paraaortic in 4.2%, common iliac in 5%, external iliac in 4.9%, internal iliac in 7.9%, inter[[Unsupported Character - Codename ­]]iliac in 70.9% and parametric in 7.1%. Irrespective of the detection drug applied, most SLN were interiliac (Blue 70%, Tc 67%, Tc and Blue 71%). Combined application of technetium and blue dye revealed significantly more SLN in the paraaotic region (p=0,006). Adenocarcinomas and squamous carcinomas did not differ in the distribution of SLN (p=0,205). The majority of SLN are interiliac in all tumor stages (FIGO IA 76%, IB 68%, IIA 61%, IIB 83%, III and IV 88%).ConclusionsRegardless of FIGO stage and histology, more than 80% of SLN were detected in the external iliac, interiliac and obturator area. On the basis of this results, no selective compromizing can be recommended e.g. of the iliac commun or presacral area in generating target volumes. All these lymph node areas should be included. BackgroundThere are only limited data regarding the mapping of the removed sentinel lymph nodes (SLN). A correlation between the localization of SLN and the tumor stage, histology or marker substance has never been investigated. There are only limited data regarding the mapping of the removed sentinel lymph nodes (SLN). A correlation between the localization of SLN and the tumor stage, histology or marker substance has never been investigated. Purpose/Objective(s)We investigated whether the distribution of SLN would have an impact on radiation target volumes. We investigated whether the distribution of SLN would have an impact on radiation target volumes. Materials/MethodsBetween 2/2000 and 6/2005 the SLN distribution of 151 patients with histologically confirmed cervical cancer (FIGO stages IA n= 21, IB n=95, IIA n=14, IIB n=18, IIIB n=2, IVA n=1), who participated in the ongoing “Uterus 3” sentinel study of the German Association of Gynecologic Oncologists (AGO), were retrospectively analysed with respect to the histology, tumor stage and detection substance. The tumors comprised mostly squamous cell carcinomas (75.5%) with a smaller fraction of adenocarcinomas (24.5%). Between 2/2000 and 6/2005 the SLN distribution of 151 patients with histologically confirmed cervical cancer (FIGO stages IA n= 21, IB n=95, IIA n=14, IIB n=18, IIIB n=2, IVA n=1), who participated in the ongoing “Uterus 3” sentinel study of the German Association of Gynecologic Oncologists (AGO), were retrospectively analysed with respect to the histology, tumor stage and detection substance. The tumors comprised mostly squamous cell carcinomas (75.5%) with a smaller fraction of adenocarcinomas (24.5%). ResultsAltogether 406 SLN, an average of 2.7 (1-7) SLN per patient, were removed. More than one SLN was detected in 111 patients (73.5%). SLN sites were paraaortic in 4.2%, common iliac in 5%, external iliac in 4.9%, internal iliac in 7.9%, inter[[Unsupported Character - Codename ­]]iliac in 70.9% and parametric in 7.1%. Irrespective of the detection drug applied, most SLN were interiliac (Blue 70%, Tc 67%, Tc and Blue 71%). Combined application of technetium and blue dye revealed significantly more SLN in the paraaotic region (p=0,006). Adenocarcinomas and squamous carcinomas did not differ in the distribution of SLN (p=0,205). The majority of SLN are interiliac in all tumor stages (FIGO IA 76%, IB 68%, IIA 61%, IIB 83%, III and IV 88%). Altogether 406 SLN, an average of 2.7 (1-7) SLN per patient, were removed. More than one SLN was detected in 111 patients (73.5%). SLN sites were paraaortic in 4.2%, common iliac in 5%, external iliac in 4.9%, internal iliac in 7.9%, inter[[Unsupported Character - Codename ­]]iliac in 70.9% and parametric in 7.1%. Irrespective of the detection drug applied, most SLN were interiliac (Blue 70%, Tc 67%, Tc and Blue 71%). Combined application of technetium and blue dye revealed significantly more SLN in the paraaotic region (p=0,006). Adenocarcinomas and squamous carcinomas did not differ in the distribution of SLN (p=0,205). The majority of SLN are interiliac in all tumor stages (FIGO IA 76%, IB 68%, IIA 61%, IIB 83%, III and IV 88%). ConclusionsRegardless of FIGO stage and histology, more than 80% of SLN were detected in the external iliac, interiliac and obturator area. On the basis of this results, no selective compromizing can be recommended e.g. of the iliac commun or presacral area in generating target volumes. All these lymph node areas should be included. Regardless of FIGO stage and histology, more than 80% of SLN were detected in the external iliac, interiliac and obturator area. On the basis of this results, no selective compromizing can be recommended e.g. of the iliac commun or presacral area in generating target volumes. All these lymph node areas should be included.