Ipsilateral Lymph Research Articles

Incidental irradiation of the regional lymph nodes during deep inspiration breath-hold radiation therapy in left-sided breast cancer patients: a dosimetric analysis

BackgroundRadiotherapy using the deep inspiration breath-hold (DIBH) technique compared with free breathing (FB) can achieve substantial reduction of heart and lung doses in left-sided breast cancer cases. The anatomical organ movement in deep inspiration also cause unintended exposure of locoregional lymph nodes to the irradiation field.MethodsFrom 2017–2020, 148 patients with left-sided breast cancer underwent breast conserving surgery (BCS) or mastectomy (ME) with axillary lymph node staging, followed by adjuvant irradiation in DIBH technique. Neoadjuvant or adjuvant systemic therapy was administered depending on hormone receptor and HER2-status.CT scans in FB and DIBH position with individual coaching and determination of the breathing amplitude during the radiation planning CT were performed for all patients. Intrafractional 3D position monitoring of the patient surface in deep inspiration and gating was performed using Sentinel and Catalyst HD 3D surface scanning systems (C-RAD, Catalyst, C-RAD AB, Uppsala, Sweden). Three-dimensional treatment planning was performed using standard tangential treatment portals (6 or 18 MV). The delineation of ipsilateral locoregional lymph nodes was done on the FB and the DIBH CT-scan according to the RTOG recommendations.ResultsThe mean doses (Dmean) in axillary lymph node (AL) level I, II and III in DIBH were 32.28 Gy (range 2.87–51.7), 20.1 Gy (range 0.44–53.84) and 3.84 Gy (range 0.25–39.23) vs. 34.93 Gy (range 10.52–50.40), 16.40 Gy (range 0.38–52.40) and 3.06 Gy (range 0.21–40.48) in FB (p < 0.0001). Accordingly, in DIBH the Dmean for AL level I were reduced by 7.59%, whereas for AL level II and III increased by 22.56% and 25.49%, respectively.The Dmean for the supraclavicular lymph nodes (SC) in DIBH was 0.82 Gy (range 0.23–4.11), as compared to 0.84 Gy (range 0.22–10.80) with FB (p = 0.002). This results in a mean dose reduction of 2.38% in DIBH.The Dmean for internal mammary lymph nodes (IM) was 12.77 Gy (range 1.45–39.09) in DIBH vs. 11.17 Gy (range 1.34–44.24) in FB (p = 0.005). This yields a mean dose increase of 14.32% in DIBH.ConclusionsThe DIBH technique may result in changes in the incidental dose exposure of regional lymph node areas.

Polymyositis as a paraneoplastic syndrome of a patient with primary pulmonary lymphoepithelioma-like carcinoma: a case report and literature review

BackgroundPulmonary lymphoepithelioma-like carcinoma (LELC) is a rare type of non-small cell lung cancer, which mostly occurred in non-smoking Asian populations. The prognosis of this tumor is better than other lung cancers. Polymyositis, a kind of idiopathic inflammatory myopathies, may negatively affect the prognosis of patients with lung cancer as a paraneoplastic syndrome (PNPS). LELC is seldomly accompanied by PNPS, thus the treatment strategy and prognosis should be discussed.Case presentationWe report a 49-year-old female patient who was hospitalized for “symmetric limb weakness and pain for more than 2 months”. Glucocorticoid-based anti-inflammatory therapy had been performed for over 3 weeks before the patient was hospitalized, however, in vain. The result of serum autoimmune antibody showed Anti-nRNP/Sm ( +). The serum level of myoglobin, lactate dehydrogenase and creatine kinase elevated significantly. An electromyogram revealed peripheral nerves injury and myogenic damages. Imaging showed a mass in the posterior basal segment of the left lung. A percutaneous transthoracic needle biopsy was performed and the pathological result was LELC. The patient was diagnosed with pulmonary LELC accompanied by polymyositis. Positron emission tomography-computed tomography (PET-CT) showed only ipsilateral hilar and mediastinal lymph nodes metastasis. Video-assisted thoracoscopic left lower lobectomy and systematic mediastinal lymphadenectomy were performed. The postoperative pathological stage was T2N2M0, IIIA (UICC 8th), and the patient received adjuvant chemotherapy and subsequent radiotherapy. The patient was followed up for 5 months with no recurrence of tumor and the limb weakness and pain were relieved apparently after the successful comprehensive treatment of her primary tumor.ConclusionPulmonary LELC is a rare subtype of non-small cell lung cancer seldomly accompanied by PNPS. Though polymyositis is associated with lung cancer, it is easy to ignore this relationship when a patient is diagnosed with LELC in the clinic. Surgery based comprehensive treatment of primary tumor can lead to a prospective prognosis in pulmonary LELC patients with PNPS. And successful treatment of pulmonary LELC can also improve symptoms of PNPS.

Abstract P1-01-01: Prospective ultrasonographic surveillance study for incidence and recovery period of COVID-19 vaccination-related axillary lymphadenopathy

Abstract Background: COVID-19 vaccination-related lymphadenopathy is a frequent imaging finding which may be indistinguishable from malignant nodal involvement and lead to diagnostic difficulties in patients with cancer or healthy individuals on cancer screening. An expert panel of the leading cancer centers in United States recommended routine imaging examinations should be scheduled at least 6 weeks after the final vaccination to allow for any reactive lymphadenopathy to resolve. However, there were no prospective trials regarding COVID-19 vaccination-related lymphadenopathy and the evidence was so limited. The purpose of this study was to determine the incidence and imaging characteristics of COVID-19 vaccination-related axillary lymphadenopathy and assess the recovery period. Methods: We prospectively enrolled healthy women working at the St. Luke’s International Hospital who received Pfizer COVID-19 vaccination within 8 weeks before enrollment between May 10th and 27th, 2021. Women with a history of any type of cancer or axillary surgery, active atopic dermatitis and auto-immune disease were excluded. Participants underwent ultrasound examinations for bilateral axilla at the enrollment. Lymphadenopathy was defined as demonstrating an enlarged node(s) with more than 5mm in short axis by ultrasound imaging in this trial. As for imaging characteristics, status of cortical thickening, echogenic hilus and vascularity of lymph nodes were evaluated. Other side effects by vaccination were assessed by a questionnaire. If lymphadenopathy was detected, we followed the participant by ultrasound examination every three weeks until the lymphadenopathy was resolved. We evaluated the incidence rate and imaging characteristics of lymphadenopathy detected by ultrasound examination, and the recovery period required for improvement of the lymphadenopathy. We also validated the association of the lymphadenopathy with the participant characteristics and other side effects. Results: A total of 135 women were enrolled in this study. Participants' median age was 37 years (range 23-63). Median time from the latest vaccination to the enrollment was 45 days (range 8-56). In the ultrasound examination at enrollment, axillary lymphadenopathy was observed in 67 participants (50%) on the injected (ipsilateral) side. In the contralateral axilla, 13 participants (10%) showed lymphadenopathy. In the ipsilateral axilla, the number of enlarged node(s) was 1 node in 25 cases (19%), 2 nodes in 24 cases (18%), 3 nodes in 13 cases (10%), 4 nodes in 4 cases (3%) and 5 nodes in 1 case (1%). Regarding the ipsilateral enlarged lymph node, focal cortical thickening was observed in 58 cases (43%) and the absence of the echogenic hilus was observed in 15 cases (11%). Hypervascularity was observed in 15 cases (11%). Incidence of the lymphadenopathy was not statistically correlated with participant’s age or incidence of fever due to vaccination. At 6 weeks after the latest vaccination, the rate of ipsilateral axillary lymphadenopathy was 48%, 40% at 8 weeks, and 6% at 12 weeks. In participants with lymphadenopathy, median recovery period to resolve the lymphadenopathy was 75 days from the latest vaccination. Conclusion: A half of participants showed COVID-19 vaccination-related axillary lymphadenopathy and the imaging characteristics were often indistinguishable from malignant nodal involvement. Therefore, patients with breast cancer should be vaccinated on the contralateral arm to the cancer side to avoid diagnostic conundrum. The lymphadenopathy was commonly observed even in 8 weeks, and mostly resolved after 12 weeks from the vaccination. Therefore, non-urgent imaging examinations such as screening would be recommended to be scheduled at least 12 weeks following the latest vaccination. Citation Format: Kumiko Kida, Hiroko Tsunoda, Risa Kasahara, Chika Tsutsumi, Akiko Numata, Yuri Takehara, Atsushi Yoshida, Junko Takei, Naoki Hayashi, Daiki Kobayashi, Hideko Yamauchi. Prospective ultrasonographic surveillance study for incidence and recovery period of COVID-19 vaccination-related axillary lymphadenopathy [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-01-01.

Abstract P3-20-02: The association of clinicopathological variables and patient´s preference with surgical decision-making for early breast cancer

Abstract Background: Mastectomy (Mx) and breast conserving surgery (BCS) when combined with adjuvant whole breast radiotherapy (RT) have been shown to give equivalent outcome in randomized trials . In recent years, a number of retrospective population-based studies suggest that BCS offers superior survival compared to Mx. In these studies, treatment has not been randomized, but selected based on patient and tumour characteristics or patient´s own choice. The aim of this study was to compare clinicopathological variables in women with tumours less than 30mm in size treated with either BCS or Mx, where both surgical methods would have been feasible based on postoperatively recorded tumour characteristics. Our second aim was to explore the underlying reason for choosing Mx as surgical approach. Method: The study is a population-based retrospective analysis of prospectively collected data from the Swedish National Breast Cancer Register (NBCR). The source population are women registered with primary invasive breast cancer with a tumour size up to 30 mm and no more than four positive axillary lymph nodes, treated between 2013-2016 in the northern health care region in Sweden. During this time period, the reason for selecting Mx was registered in this region with five optional alternatives: 1.Age &amp;lt; 40 years, 2.Large tumour size/extent relative breast volume, 3.Multifocality/multicentricity, 4.RT contraindicated due to comorbidity and 5.Patient´s own choice. All cases with male breast cancer and patients treated with neoadjuvant therapy were excluded.Logistic regression analyses were performed to assess the association of tumour and patient characteristics with receiving a mastectomy shown as odds ratios with 95% confidence intervals (CI). Results: A total of 1860 women met our inclusion criteria, 1346 of which had undergone BCS (mean age 63) and 514 Mx (mean age 66). For 1309 women (97.1%) in the BCS group and 146 (27.6%) in the Mx group adjuvant RT was added to the breast, chest wall and/or ipsilateral regional lymph nodes after surgery. Clinical detection, OR 3.35 (95%CI 3.32-5.14), higher T stage OR 2.66 (2.00-3.54), N stage OR 1.84 (1.46-2.32) and multifocality, OR 4.59 (3.56-5.92) were associated with a higher likelihood of receiving Mx. Women treated with Mx had more lobular tumours, OR 1.42 (1.05-1.92), higher grade, OR 2.27 (1.65-3.13), more hormone receptor negative, 1.47 (1.09-1.98) and HER2 positive tumours, OR 1.61 (1.19-2.17) compared to women treated with BCS.The most common reason for choosing Mx was large tumour size and/or multifocality (52.8%). The second most common reason was the woman´s own preference (36.6%). In 9 % of the cases RT was considered contraindicated, hence Mx was recommended by the treating surgeon or tumour board. Conclusion: Women with invasive breast cancer up to 30mm selected for treatment with Mx have less favourable prognostic characteristics than those treated with BCS. Selection bias may largely explain the survival benefits of BCS compared to Mx demonstrated in observational studies. Table 1: Distribution of factors listed as reason of mastectomy as surgical treatment. Table based on a a total of 431 mastectomy cases where reason for Mx were listed. RT = Radiotherapy No. of patients%Age &amp;lt; 40 years61.4large tumour size/extent relative breast volume13531.3Multifocality/multicentricity9321.5RT contraindicated due to comorbidity399.0Patients own choice15836.6 Citation Format: Emma Söderberg, Malin Sund, Fredrik Wärnberg, Lars Holmberg, Greger Nilsson, Hans Garmo, Carl Blomqvist, Charlotta Wadsten. The association of clinicopathological variables and patient´s preference with surgical decision-making for early breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-20-02.

Prophylactic bilateral central neck dissection should be evaluated based on prospective randomized study of 581 PTC patients

BackgroundProphylactic central lymph node dissection (PCND) was a basic consensus for patients with papillary thyroid carcinoma (PTC) in China. However, unilateral or bilateral central lymph node dissection (CND) was still controversial. This study aimed at investigating the safety and long-term benefit for the patients undergone with bilateral central lymph node dissection (BCCD).Methods581 patients were enrolled and divided randomly into the test and control groups according to range of CND. 285 patients were prospectively assigned to undergo thyroid lobectomy plus BCND in the test group, other 296 patients were assigned to undergo thyroid lobectomy plus ipsilateral central lymph node dissection (ICND) in the control group.ResultsWe found that the numbers of total LN and pN1a in the test group were more than that of the control group (p = 0.002,0.004), but there was no difference in the number of metastasized lymph nodes (p = 0.857) and tumor recurrence (p = 0.308). Additionally, in the aspect of postoperative complication (1 day after surgery), the serum levels of parathyroid hormone in the BCND group were lower than that in the ICND group (P = 0.010), and the numbers of transient laryngeal nerve palsy were more than that(p = 0.033). Meanwhile, we further found that pathological tumor size larger than 1 cm and tumor side lymph node metastasis were independent risk factors for contralateral central lymph node metastasis(p = 0.002,0.001).ConclusionBCND may be an alternative for patients with tumor sizes larger than 1 cm, but it would significantly increase the rate of transient vocal cord palsy, parathyroid auto transplantation and decreased PTH, but the risk of permanent complications was similar to the ICND group.

Parotid Salivary Gland Extramedullary Plasmacytoma with Local Lymph Node Metastasis in a Dog

ABSTRACTA 12 yr old spayed female mixed-breed dog presented for evaluation of a recurrent soft-tissue sarcoma. On physical examination, a firm mass was palpated ventral to the left ramus of the mandible. A fine-needle aspirate of the mass was suggestive of a round-cell neoplasm. A complete blood count, serum biochemical profile, and an abdominal ultrasound with liver and splenic aspirates were performed, and no clinically relevant abnormalities were identified. Advanced imaging of the skull identified an enlarged parotid salivary gland and an enlarged ipsilateral medial retropharyngeal lymph node. The medial retropharyngeal lymph node was sampled via fine-needle aspiration, and a round-cell population similar to what was present in the mass was identified. An incisional biopsy was performed under general anesthesia, which yielded a diagnosis of salivary gland extramedullary plasmacytoma, confirmed with immunohistochemistry (MUM-1). The parotid salivary gland and medial retropharyngeal lymph node were then surgically excised, and metastasis to the lymph node was confirmed by histopathology. The dog remained alive for 685 days after surgery until she was euthanized for hindlimb paresis of undetermined cause.

Undifferentiated Pleomorphic Sarcoma of a Chronic Burn Scar of the Knee With Lymph Node Metastasis.

Malignant transformation of chronic burn scars are usually toward cutaneous lineages, including squamous cell carcinoma, basal cell carcinoma, and malignant melanoma. Sarcomas are less common. Undifferentiated pleomorphic sarcoma(UPS) is a subtype of soft tissue sarcoma with storiform-pleomorphic cells of uncertain origin, and has sparingly been reported to arise from burn scars. The majority are localized lesions probably due to the spatial distance of mesenchymal cells from the epithelium. The authors describe a rare case of UPS of the chronic burn scar of his knee with ipsilateral femoral and external iliac lymph node metastasis.

LOBE-SPECIFIC METASTASIS IN NON-SMALL CELL LUNG CANCER

Aim: to identify the pathways of lymph node metastases in non-small cell lung cancer (NSCLC).Material and Methods. The frequency of mediastinal lymph node metastases and treatment outcomes were analyzed in 327 patients with stage I–III non-small cell lung carcinoma (NSCLC), who underwent lung resection with systematic lymph node dissection (SLND) between 2007 and 2011.Results. In cases with tumor location in any lobe of the right lung, metastasis occurred in the superior and inferior mediastinal lymph nodes. In left-side tumors, the main pathways of lymphatic spread of tumors were superior and inferior mediastinal nodes as well as aortic lymph nodes. Left lower lobe tumors metastasized most often to inferior mediastinal lymph nodes. Skip metastases were observed at any location of the tumor. Routine examination of all ipsilateral mediastinal lymph nodes overstaged NSCLC in 19.5 % of cases. The overall 5-and 10-year survival rates in patients with stage I–III NSCLC with SND were 61.5 % and 49.2 %, respectively. The median survival time was 103 months.Conclusion. Despite typical metastatic patterns of mediastinal lymph nodes in patients with NSCLC, non-specific metastasis was observed at any location of the tumor, which required mandatory systematic nodal dissection.

Mediastinales Staging

Thorough mediastinal staging is pivotal for prognostic assessment and treatment planning in patients with non-small-cell lung cancer (NSCLC) without distant metastasis. It aims to answer the question of whether a technically and functionally feasible operation also makes sense from an oncological point of view. In case of a nodal-free mediastinum, primary surgical therapy can be considered. If the ipsilateral mediastinal lymph nodes are affected, multimodal therapy should be sought. Operating is usually no longer the first step, especially with extensive lymph node infestation. Surgery is recommended, if neoadjuvant (radio-)chemotherapy has achieved downstaging or major response. If the contralateral mediastinal lymph nodes are involved, curative surgery is no longer part of the therapeutic concept. The therapy of choice in this situation is definitive chemo-radiotherapy.Guidelines for mediastinal staging consistently require to combine radiological, nuclear medicine and minimally invasive methods. Imaging with CT and PET allows an initial assessment of the mediastinal status. In most cases it has to be complemented with tissue confirmation. Echoendoscopic assessment of the mediastinum with needle biopsy is the minimally invasive method of first choice ("needle first"). Surgical staging methods are reserved for situations, that cannot be satisfactorily clarified by echoendoscopy.Technique and outcome of the different methods are described and algorithms are presented for different oncological situations.

A Prediction Model for Contralateral Central Neck Lymph Node Metastases in Unilateral Papillary Thyroid Cancer.

The health problems caused by the frequent relapse of papillary thyroid carcinoma (PTC) remain a worldwide concern since the morbidity rate of PTC ranks the highest among thyroid cancers. Residues from contralateral central lymph node metastases (con-CLNM) are the key reason for persistence or recurrence of unilateral papillary thyroid carcinoma (uni-PTC); however, the ability to assess the status of con-CLNM in uni-PTC patients is limited. To clarify the risk factors of con-CLNM, a total of 250 patients with uni-PTC who underwent total thyroidectomy and bilateral central lymph node dissection were recruited in this study. We compared the clinical, sonographic, and pathological characteristics of patients with con-CLNM to those without con-CLNM and established a nomogram for con-CLNM in uni-PTC. We found that male sex, without Hashimoto's thyroiditis, present capsular invasion, with ipsilateral lateral lymph node metastases, and the ratio of ipsilateral central lymph node metastases ≥0.16 were independent con-CLNM predictors of uni-PTC (ORs: 2.797, 0.430, 2.538, 2.202, and 26.588; 95% CIs: 1.182–6.617, 0.211–0.876, 1.223–5.267, 1.064–4.557, and 7.596–93.069, respectively). Additionally, a preoperative nomogram for the prediction of con-CLNM based on these risk factors showed good discrimination (C-index 0.881; 95% CI: 0.840–0.923; sensitivity 85.3%; specificity 76.0%) and good agreement via the calibration plot. Our study provided a way to quantitatively and accurately predict whether con-CLNM occurred in patients with uni-PTC, which may guide surgeons to evaluate the nodal status and perform tailored therapeutic central lymph node dissection.

Prediction of ipsilateral lateral cervical lymph node metastasis in papillary thyroid carcinoma: a combined dual-energy CT and thyroid function indicators study

BackgroundPredicting the possibility of ipsilateral lateral cervical lymph node metastasis (ipsi-LLNM) was crucial to the operation plan for patients with papillary thyroid carcinoma (PTC). This study aimed to investigate the independent risk factors for ipsi-LLNM in PTC patients by combining dual-energy computed tomography (DECT) with thyroid function indicators.MethodsWe retrospectively enrolled 406 patients with a pathological diagnosis of PTC from Jan 2016 to Dec 2019. Ensure the DECT images were clear and the thyroid function indicators were complete. Univariate and multivariate logistic analyses explored the independent risk factors for ipsi-LLNM. To evaluate the cutoff value of each risk factor by using receiver operating characteristic (ROC) curves.ResultsA total of 406 patients with PTC were analyzed, including 128 with ipsi-LLNM and 278 without ipsi-LLNM. There were statistical differences of parameters between the two groups (P < .0001), including serum Tg, Anti-Tg, Anti-TPO, the volume of the primary lesion, calcification, extrathyroidal extension (ETE), and iodine concentration (IC) in the arterial and the venous phases. Independent risk factors for ipsi-LLNM included serum Tg, Anti-Tg, ETE, and IC in the arterial and the venous phases (P < .05). The combined application of the above independent risk factors can predict the possibility of ipsi-LLNM, with an AUC of 0.834. Ipsi-LLNM was more likely to occur when the following conditions were met: with ETE, Tg > 100.01 ng/mL, Anti-Tg > 89.43 IU/mL, IC in arterial phase > 3.4 mg/mL and IC in venous phase > 3.1 mg/mL.ConclusionsThe combined application of DECT quantitative parameters and thyroid function indicators can help clinicians accurately predict ipsi-LLNM before surgery, thereby assisting the individualized formulation of surgical procedures.

Distribution pattern and prognosis of metastatic lymph nodes in cervical posterior to level V in nasopharyngeal carcinoma patients

BackgroundLymph node metastasis in the cervical region posterior to level V (PLV) can occurs in patients with nasopharyngeal carcinoma (NPC), but the significance of lymph node metastasis in this region and the delineation of the radiotherapy target area have not been reported. We aimed to explore the distribution pattern and prognosis of metastatic lymph nodes in the PLV region in patients with NPC.MethodsWe retrospectively studied 605 cases of NPC diagnosed by pathological detection from December 2011 to November 2017. The nodal distribution at each level was assessed in accordance with the Radiation Therapy Oncology Group (RTOG) guidelines proposed in 2013. The central points of the metastatic lymph nodes of the PLV region in the patients were recreated proportionally on the CT images of a standard patient with N0 NPC in reference to the normal anatomy of the PLV area. The correlation between the PLV region and the other levels, the nodal location, and the characteristics and prognosis of the PLV region were analyzed.ResultsLymph node metastasis occurred in 557 (92.06%) of 605 patients. There were 30 patients (4.95%) with lymph node metastasis in the PLV region. A total of 49 metastatic lymph nodes from the PLV region were counted, and the mean vertical distance of the central point of each lymph node from the anterior surface of the trapezius muscle was 14 mm. Linear regression correlation analysis suggested that lymph node metastasis in the PLV region was associated with ipsilateral level IVa (P = 0.018), level Va, level Vb, and level Vc lymph node metastasis (all P < 0.001). The 5-year OS, PFS, LRFS, and DMFS of 29 patients with lymph node metastasis in the PLV region were 41.6, 27.7, 89.1, and 47.3%, respectively. Multivariate analysis showed that lymph node metastasis in the PLV region was an independent prognostic factor for DMFS (P < 0.05).ConclusionNPC patients with lymph node metastasis in the PLV region had a poor prognosis and a high risk of distant metastasis. We recommend that the margin of the PLV region may be a new cervical lymph node segment for NPC.

Simultaneous Ipsilateral Vascularized Lymph Node Transplantation and Contralateral Lymphovenous Anastomosis in Bilateral Extremity Lymphedema with Different Severities

BackgroundExtremity lymphedema can occur bilaterally with different severities on each side. The aim of this study is to investigate the treatment outcomes of such patients with bilateral extremity lymphedema of different severities.Patients and MethodsBetween 2013 and 2017, patients with bilateral extremity lymphedema of different severities according to the Taiwan Lymphoscintigraphy Staging (TLS) system were retrospectively reviewed. Ipsilateral vascularized lymph node transplantation (VLNT) was indicated in TLS total obstruction and contralateral lymphovenous anastomosis (LVA) in TLS partial obstruction with patent lymphatic vessels on indocyanine green lymphography. Outcomes were assessed using circumference improvement, frequency of cellulitis, and lymphedema-specific quality of life (LYMQoL) questionnaires.ResultsA total of 10 patients with bilateral extremity lymphedema with median age of 63 (range 12–75) years were included. The median symptom duration of the lymphedematous limb was 60 (range 36–168) months and 12 (range 1–60) months in the VLNT and LVA group, respectively (p < 0.05). At average follow-up of 37.5 (range 14–58) months, the average limb circumference improvement was 2.4 (range − 3.3 to 7.8) cm in the VLNT group and 2.3 (range 0.3–7) cm in the LVA group (p = 1). The median episodes of cellulitis decreased significantly from 4 to 0.5 and 1 to 0 times/year in the VLNT and LVA group, respectively (p = 0.02, p = 0.06). The overall LYMQoL score improved from 4.5 preoperatively to 7.5 postoperatively (p < 0.01).ConclusionsLimb-specific VLNT and LVA selected by TLS effectively treated bilateral extremity lymphedema with different severities.

A retrospective analysis on metastatic rate of the internal mammary lymph node and its clinical significance in adjuvant radiotherapy of breast cancer patients

BackgroundThere is a discrepancy about the metastatic rate of internal mammary lymph nodes (IMNs) between clinical and pathologic findings. We aimed to investigate the metastatic rate of IMNs and to provide recommendations on target volume delineation of IMNs for adjuvant radiotherapy in breast cancer patients.MethodsWe retrospectively analyzed data from 114 breast cancer patients treated with surgery without adjuvant radiotherapy who developed local and/or regional lymph node recurrence/metastasis at our institute from January 2015 to January 2019. Patients with widely lung or pleural metastases were excluded. We first analyzed the recurrence rate with the chest wall, the metastatic rate of internal mammary/anterior mediastinal, ipsilateral axillary and supraclavicular lymph nodes, and then investigated the distribution of the IMNs.ResultsAmong the 114 included patients, the recurrence rate with the chest wall, metastatic rate of IMNs, IMNs/anterior mediastinal lymph nodes, ipsilateral axillary lymph nodes, and the ipsilateral supraclavicular lymph nodes was 43, 37.7, 59.6, 12.3, and 22.8%, respectively. The metastatic IMNs were mainly located from the first to the second intercostal space. However, metastatic lymph nodes could also be observed above the upper edge of the first rib.ConclusionsThe metastatic rate is high in the IMNs and irradiation of the internal mammary lymphatic chain is required. It is suggested that the upper bound of the internal mammary lymphatic chain should be up to the subclavian vein with a 5-mm margin, thus connecting to the caudal border of supraclavicular clinical target volume in breast cancer patients at high risk of recurrence.

Abstract P5-08-18: Mortality rates associated with clinical and pathological characteristics of hormone receptor positive human epidermal growth factor receptor 2 negative early breast cancer: An analysis of the 2010-2016 surveillance, epidemiology, and end results data

Abstract Background: Breast cancer in the United States is diagnosed in over 90% of cases prior to evidence of distant metastasis (stages I–III) with approximately 70% of these cases classified as hormone receptor positive human epidermal growth factor receptor 2 negative (HR+HER2-).1 Despite primary surgery, radiation, and adjuvant endocrine/chemotherapy treatment options, approximately 20-30% of patients will experience relapse with distant metastases.2 Some clinical and pathological characteristics are known to be prognostic factors, but there are no standard definitions associated with level of risk. The objective of this study was to determine the extent of mortality associated with clinical and pathological characteristics of early breast cancer (EBC) using real-world data. Methods: Eligible patients from 2010–2016 Surveillance, Epidemiology, and End Results (SEER) data were aged ≥18 years and had a diagnosis of stage I, II, or III breast cancer with no distant metastases. Patients with HR-HER2- breast cancer were excluded. Mortality rates (95% confidence interval) by HER2 status and, for HR+HER2- tumors, by cancer stage, Bloom-Richardson (BR) grade, ipsilateral auxiliary lymph nodes status, and tumor size were estimated using Kaplan-Meier methods. Results: A total of 257,278 breast cancer patients were included: 214,578 HR+HER2-, 30,122 HR+HER2+, and 12,578 HR-HER2+. Mean age was 61.5 years, 99.1% were female, and 70.1% were white/non-Hispanic. The 5-year mortality rates were similar for HR+HER2- (12.3%) and HR+HER2+ (12.2%), whereas HR-HER2+ was numerically higher (16.8%). Within the HR+HER2- group, the 5-year mortality rates for subgroups are shown in Table 1. The highest mortality rate for both the node positive and micrometastases subgroups was approximately 30% for those who had 1–3 ipsilateral auxiliary lymph nodes, BR grade 3, and tumor size ≥5 cm. Conclusions: Patients with HR+HER2- EBC had similar mortality rates to patients with HR+HER2+ EBC. In patients with HR+HER2- EBC, higher mortality rates were numerically associated with ≥4 positive lymph nodes, BR grade 3, and greater tumor size. The effect on mortality was compounded with combinations of these histopathologic characteristics.

Общая выживаемость больных немелкоклеточным раком легкого группы pN2 после радикальной операции и послеоперационной лучевой терапии

Purpose: Comparative analysis of the overall survival (OS) in different subgroups of the patients with non-small cell lung cancer (NSCLC) with affected mediastinal lymph nodes (pN2) after surgical and combined treatment using postoperative radiotherapy (PORT). &#x0D; Material and methods: A comparative assessment of the overall survival of 243 patients with NSCLC stages IIIA, IIIB (pT1–4N2M0) was carried out: the I group – 79 patients after radical (R0) surgical treatment (lobe/bilobectomy, pulmonectomy with ipsilateral mediastinal lymph node dissection) and the second group – 164 patients after the combined modality therapy with the same volume of surgery and postoperative radiotherapy in the mode of hypofractionation (daily dose 3 Gy, 5 times a week, TD = 36–39 Gy (EQD2 = 43.2–46.8 Gy, α/β = 3) or classical fractionation (2 Gy, 5 times a week, TD = 44 Gy). We analyzed subgroups of men and women, patients younger than 60 years and older, with central and peripheral cancer, squamous cell carcinoma and adenocarcinoma, with different gradation of tumors according to the criterion T (pT1–4). &#x0D; Results: In the compared groups, 2-year and 5-year OS was significantly higher in the PORT group (62.4 and 31.6 vs 44.8 % and 12.3 %, p = 0.0028), at the expense of male patients (62.4 and 31.6 % vs 44.8 and 12.3 %, p = 0.0028), patients with central cancer (59.2 and 43.7 % vs 36.3 % and n/a, p = 0.0023), patients with squamous cell carcinoma (64.0 % and 43.1 % vs 42.3 % and 6.7 %, p = 0.0006), patients older than 60 years (74.8 and 46.2 % vs 45.1 % and n/a, p = 0.007). A more detailed analysis revealed that PORT significantly increased 2- and 5-year OS in the central squamous cell carcinoma of the lung (67.3 and 53.0 % vs. 33.3 and 0 %, respectively, p = 0.0013), and in pT3–4 tumors (2-year OS 57.1 vs. 36.4 %, respectively, p = 0.0102). There was only a tendency of increasing OS after the PORT in T2 tumors (5-year OS 31.1 vs 15.4 %, respectively, p = 0.1319). In T1 tumors, no differences in OS were found, possibly due to the small number of cases (27). In peripheral squamous cell carcinoma there was a statistically insignificant increasing of 5-year OS – 7 %. There was no significant differences in OS survival were obtained in central and peripheral lung adenocarcinoma between the I and II groups. &#x0D; Conclusion: In the patients with non-small cell lung cancer pN2, radically operated (R0) in the volume of lobe/bilobectomy, pulmonectomy with ipsilateral mediastinal lymph node dissection, PORT can be recommended for central squamous cell carcinoma pT1–4. In the patients with peripheral squamous cell carcinoma, PORT can be discussed for the patients with individually assessed high risk of the locoregional relapse. PORT, within the scope of irradiation and total doses used in this study, has no age restrictions. The feasibility of PORT for radically operated patients with pN2 lung adenocarcinoma requires further study.

Impact of ipsilateral lobar lymph node dissection on survival in the combined treatment of non-small cell lung cancer

Impact of ipsilateral lobar lymph node dissection on survival in the combined treatment of non-small cell lung cancer

Popliteal nodal metastasis from squamous cell cancer of the foot. Case report and literature review

We report a very rare case of squamous cell cancer of the right foot which had metastasize to the ipsilateral popliteal lymph node after initial diagnosis and treatment for the loco-regional disease.

Management of Locoregional Recurrence of Breast Cancer

Following treatment for breast cancer, disease can recur locally, regionally, or at distant sites. Locoregional recurrence is defined as recurrence in the ipsilateral breast, skin, chest wall, or regional lymph nodes. Concurrent metastatic disease is common in patients with locoregional recurrence; therefore, patients with recurrence should undergo a complete metastatic work-up. Isolated locoregional recurrence should be approached with curative intent, and patients should undergo resection and adjuvant therapy, as indicated, based on previous treatment and location of recurrence. Following treatment for locoregional recurrence, close monitoring should be performed, as patients are at an increased risk for developing metastatic disease. This review contains 5 figures, 1 table, and 50 references Key Words: breast cancer, CALOR clinical trial, locoregional recurrence, repeat radiation therapy, repeat sentinel lymph node mapping, adjuvant chemotherapy, repeat breast conserving therapy, mastectomy

Management of Locoregional Recurrence of Breast Cancer

Following treatment for breast cancer, disease can recur locally, regionally, or at distant sites. Locoregional recurrence is defined as recurrence in the ipsilateral breast, skin, chest wall, or regional lymph nodes. Concurrent metastatic disease is common in patients with locoregional recurrence; therefore, patients with recurrence should undergo a complete metastatic work-up. Isolated locoregional recurrence should be approached with curative intent, and patients should undergo resection and adjuvant therapy, as indicated, based on previous treatment and location of recurrence. Following treatment for locoregional recurrence, close monitoring should be performed, as patients are at an increased risk for developing metastatic disease. This review contains 5 figures, 1 table, and 50 references Key Words: breast cancer, CALOR clinical trial, locoregional recurrence, repeat radiation therapy, repeat sentinel lymph node mapping, adjuvant chemotherapy, repeat breast conserving therapy, mastectomy