Isolated Lymph Node Recurrence Research Articles

Re-irradiation for isolated neck recurrence in head and neck tumor: impact of rN category

Unresectable, isolated lymph node recurrence after radiotherapy is rare but a candidate for re-irradiation. However, severe toxicity is anticipated. Therefore, this study aimed to explore the efficacy and toxicity of re-irradiation in isolated lymph node recurrence of head and neck lesions. We analyzed 46 patients who received re-irradiation for lymph node recurrence without local progression. The primary tumor sites included the oral cavity in 17 patients, the hypopharynx in 12, the oropharynx in seven, the larynx in three, the nasopharynx in two, and other sites. During a median follow-up time of 10 months, the median survival time was 10.6 months, and the 1-year overall survival rate was 45.5%. The 1-year local control and progression-free survival rates were 49.8% and 39.3%, respectively. According to univariate analysis, age (≥ 65 years), the interval between treatment (≥ 12 months), rN category (rN1), and gross tumor volume (GTV < 25 cm3) were predisposing factors for better survival. In the multivariate analysis, the rN category and interval were identified as statistically significant predictors. Late toxicity grade ≥ 3 occurred in four patients (8.6%). These were all Grade 5 carotid blowout syndrome, which associated with tumor invasion of the carotid artery and/ or high doses administration for the carotid artery. Small-volume rN1 tumor that recur after a longer interval is a feasible candidate for re-irradiation. However, strict patient selection and meticulous care for the carotid are required.

Long-term outcomes of patients with oral cavity cancer receiving postoperative radiotherapy after salvage neck dissection for cervical lymph node recurrence.

We aimed to clarify the outcomes of postoperative radiotherapy (PORT) after salvage neck dissection for cervical lymph node (LN) recurrence in oral cavity cancer. We retrospectively evaluated overall survival (OS), recurrence-free survival (RFS), recurrence patterns, and adverse events of 51 patients with high-risk features receiving PORT after salvage neck dissection between 2009 and 2019. After a median follow-up of 7.4 years from PORT initiation, the 7-year OS and RFS rates were 66.3% (95% CI: 54.0-81.3) and 54.6% (95% CI: 42.1-70.9), respectively. Age <70 years and isolated LN recurrence were significantly associated with longer OS and RFS. Among the 22 patients who experienced recurrence, 14 experienced recurrence within the radiation field. PORT-related grade 3 acute mucositis (35%) and late adverse events (osteoradionecrosis [4%] and laryngeal stenosis [2%]) were observed. PORT after salvage neck dissection for cervical LN recurrence achieved good survival with acceptable toxicity.

Long-Term Outcomes in a Phase II Study of Hypofractionated IGRT 60Gy/ 20F in Patients with Isolated Lymph Node Recurrence after Surgery for Esophageal Carcinoma

In oligo metastases in lymph node recurrence after surgery for esophageal cancer, since SBRT (BED>100 Gy10) to mediastinal and abdominal lymph node lesions was not an option due to toxicities in the organs at risk (OAR) such as vessels and gastrointestinal tract, we performed a prospective cohort study of hypofractionated IGRT for isolated lesions. The primary end-points of this study are disease specific survival (DSS) and late treatment toxicities. From 2011 to 2021, 60 Gy/20F/4-4.5wks (78 Gy10) hypofractionated IGRT was performed in a total ITT population of 70 patients after radical surgery (67 cases) and ESD (3 cases), who were diagnosed by CT/PET-CT as having solitary lymph node recurrence (62 cases) or up to 2 adjacent nodes (8 cases). The mean time from surgery to recurrence was 17.9 months (SD 18.1) with a mean age of 67.5 years (SD 9.3), and male to female ratio was 62:8. Pathological results showed that 63 patients (90%) had squamous cell carcinoma. The mean maximum diameter of lesions was 2.5 cm (SD; 1.1 cm). And 51 cases (73%) were treated with CRT concurrently using 5FU plus CDDP (FP), and the rest were treated with RT alone. Lymph node location was lower neck or upper mediastinum in 42 cases, middle and lower mediastinum in 16 cases, and abdomen in 12 cases, respectively. Treatment planning was performed by taking 4DCT fusing PET or MRI images. The Kaplan-Meier method and the Cox proportional hazards regression model were used for overall survival (OS), DSS, and progression free survival (PFS). The mean observation period was 38 months. Primary efficacy was CR in 45 cases (64%), but CR was maintained only in 29 cases (41%). Twenty-two of the 70 patients were relapse-free. OS were 53% and 34% at 2 and 5 years, DSS were 56% and 38% at 2 and 5 years, and PFS were 40% and 39% at 2 and 5 years, respectively. The site of first recurrence was the same or adjacent lymph nodes in 33 cases (47%) and distant metastases in 9 cases (13%). Number of tumors (1 vs. 2), age, and CRT were not significant prognostic factors for OS, DSS, or PFS. In a multivariate analysis, the time from surgery to recurrence ≥12 months was the only significant prognostic factor for PFS (p = 0.018, HR0.50). The same multivariate analysis showed that the only significant prognostic factor for DSS was the location of the recurrent lymph node in the neck and upper mediastinal regions (p = 0.009, HR 0.59). The only late adverse events of Grade 2 or higher were Grade 2 pleural effusion (little and transient) in 6 cases and Grade 2 radiation pneumonitis in 1 case. No acute adverse events were observed other than hematologic toxicity due to FP administration. In locally advanced esophageal cancer, a relatively reliable regional lymph node dissection is often performed, so there is still a chance to aim for cure in cases of solitary recurrence. We found that if the lesion is solitary, localized RT of about 60 Gy/20F/4-4.5 weeks with IGRT can achieve a long-term survival in 40% of patients without any significant adverse events.

Isolated lymph node recurrence in epithelial ovarian cancer-management and outcome.

The aim of our study was to assess the clinical outcome of isolated lymph node recurrence in patients with epithelial ovarian cancer treated by surgery and to analyze the impact of various clinico-pathological factors on prognosis. We conducted a retrospective analysis of all the epithelial ovarian cancer patients who underwent secondary lymphadenectomy surgery for isolated lymph node recurrence at our institute from 2013 to 2020. Univariate analysis of various factors influencing the post-recurrence disease free survival and post-recurrence survival was done using Kaplan-Meier for categorical variables and cox-proportional hazard progression for continuous variables. A total of 21 patients of isolated lymph node recurrence were treated surgically during the study period. The median disease free interval to develop lymph nodal recurrence was 13 months. All the patients achieved complete resection to no gross residual disease without any significant morbidity associated with the procedure. The median post-recurrence disease free survival after treatment of lymph node recurrence was 25 months with 3-year post-recurrence survival of 72% and 3-year overall survival of 85%. Amongst the factors influencing post-recurrence disease free survival, young age (<50 years), para-aortic lymph node dissection at initial surgery and single site of lymph node recurrence were significantly associated with better prognosis. A single site of lymph node recurrence was associated with significantly better post-recurrence survival. Complete resection is feasible for epithelial ovarian cancer patients presenting with isolated lymph node recurrence, without any significant perioperative morbidity. When combined with postoperative adjuvant chemotherapy, complete resection is associated with favourable survival outcomes. Young age, para-aortic lymph node dissection during primary surgery and single site of lymph node recurrence are associated with better prognosis.

Proton SBRT for Isolated Nodal Recurrence in Gynecological Cancers

<h3>Purpose/Objective(s)</h3> Stereotactic body radiotherapy (SBRT) for isolated lymph node recurrence has been shown to have good rates of local control (LC) in gynecological cancers. However there exists the risk of toxicities to nearby organs. This single institution, retrospective outcome and dosimetric analysis assesses treatment response, associated GI and GU toxicities and associated characteristics for improved or worsened outcomes with proton based SBRT, hypothesizing that there will be low rates of toxicities while maintaining beneficial outcomes. <h3>Materials/Methods</h3> Adult patients diagnosed with primary gynecologic malignancy with isolated nodal recurrence treated with proton SBRT from 2006-2021 at a single institution were included. Toxicities were evaluated using RTOG/EORTC and CTCAE grading. Descriptive statistics were used to describe characteristics associated with local recurrence, toxicity, and survival. <h3>Results</h3> Fourteen patients with 21 nodal lesions were treated with 19 courses of proton SBRT. Median age was 64.5 (range: 47-78) years at time of initial cancer diagnosis and median of 66.0 (range: 51- 80) years at initial lymph node recurrence. Patients recurred within an average of 13.00 (range: 0.66- 31.41) months from end of initial treatment. Primary cancer sites included endometrium (n= 9), cervix (n= 2), ovary (n= 2), and vagina (n= 2). SBRT doses ranged from 30- 50 Gy (median 40 Gy) in 5-15 fractions with mean BED (alpha beta 10) of 69.93 (range: 48.00- 100.00) and mean BED (alpha beta 3) of 139.95 (range: 72.00- 216.67). Nodal locations treated included para-aortic (n= 7), pelvis (n= 5), iliacs (n= 4), and distant nodes (n= 3, supraclavicular, perirectal, periadrenal). Three pelvic and iliac lesions recurred locally at a median of 2.9 months (range 1.25-29.23) and 50% of patients developed local or distant recurrence. Local control at 3 months, 6 months, 1 year, and 2 years was 84.6%, 83.3%, 81.8%, and 70.0% respectively. Local recurrence free survival (LRFS) at 1 year and 2 years was 80.0%, 75.0% and overall survival (OS) was 54.5%, 44.4% respectively. Six patients developed grade 1 or 2 GI treatment related toxicity (Grade 1: 3, Grade 2: 3). 2 patients developed grade 1 GU toxicity. There were no GI grade 3-5 toxicities or GU grade 2-5 toxicities. Average Dmax to bladder was 14.42 Gy (median 18.62 Gy), range (0.6- 30.6). Average rectum Dmax was 15.75 Gy (range: 0.1- 34.2), median: 15.8 Gy. Median small bowel D2cc was 27 Gy (range: 10- 50.5) <h3>Conclusion</h3> Patients treated with proton SBRT had excellent rates of LC and LRFS and low rates of GI and GU toxicity. Dosimetric analysis also demonstrates low dose to nearby OARs. Based on these findings, Phase I/II trials evaluating dose escalation using proton techniques to further improve local control of isolated nodal recurrences should be considered.

Role and survival benefits of secondary surgery in ovarian carcinoma patients with isolated lymph node recurrence (ILNR): a comparative study

Role and survival benefits of secondary surgery in ovarian carcinoma patients with isolated lymph node recurrence (ILNR): a comparative study

Laparoscopic management of isolated nodal recurrence in gynecological malignancies is safe and feasible even for large metastatic nodes up to 8 cm: A prospective case series

BackgroundThe surgical treatment of isolated lymph node recurrence (ILNR) of gynecological malignancies is still debated. The feasibility and effectiveness of minimally invasive lymphadenectomy have been reported by few studies; however, it remains unclear what the upper tumor size limit is for a minimally invasive approach. We prospectively analyzed cases of ILNR treated by laparoscopy in our unit while focusing on the safety and feasibility of resecting large tumors suspected of recurrence using a minimally invasive approach. Materials and methodsWe carried out a prospective observational case-series study. We included all consecutive patients with ILNR from gynecological cancers who underwent minimally invasive lymphadenectomy at our unit from June 2013 to June 2021 to assess the safety and feasibility of such a surgical approach. We also evaluated the oncological outcome in terms of further recurrence, site of recurrence, and survival. ResultsTwenty-seven patients with ILNR due to gynecological malignancies were included (ovarian cancer, 12; uterine malignancies, 12; cervical cancer, 3). Three had remarkably large LNs up to 8 cm: these emblematic cases have been reported in detail with accompanying videos of the surgical procedure. The most frequent site of ILNR was aortic (67%). Recurrent LNs were completely resected in all cases; none of the procedures was converted to open surgery. The median follow-up duration was 24 months. Ten patients (37%) had a new recurrence. To date five patients (18.5%) have succumbed, four (14.8%) are alive with evidence of disease, and 18 (66.7%) are alive with no evidence of disease. ConclusionsMinimally invasive surgery for ILNR in gynecological malignancies may be an option feasible, safe, and effective in terms of oncological outcomes, even for large tumors. It also allows quicker recovery with early initiation of appropriate postoperative systemic chemotherapy, in the context of an optimal multimodal therapeutic approach.

THE VALUE OF CYTOREDUCTIVE SURGERY FOR ISOLATED LYMPH NODE RECURRENCE OF OVARIAN CANCER

The purpose of the study was to undertake a systematic literature review regarding the role of cytoreductive surgery in treatment of recurrent ovarian cancer, as well as to summarize available data on various current studies and estimate indications for secondary cytoreduction in recurrent ovarian cancer with isolated lymph node involvement.Material and Methods. The search for relevant sources was carried out in PubMed, Gynecol Oncol, Medline, NCCN, Elibrary systems; publications were included from January 2006 up to March 2019. Of the 87 studies found, 26 were used to write a systematic review.Results. Ovarian cancer (OC) remains the leading cause of death from gynecological cancer. The initial treatment for IC-IV stages of OC includes surgical cytoreduction followed by platinum-containing chemotherapy. The best outcomes are observed in patients, in whom complete cytoreduction has been achieved. Despite this fact, most patients develop relapses and the 5-year survival rate is about 30 %. The frequency of lymph node involvement in patients with recurrent OC is not reliably known; isolated lymph node recurrence is reported to occur in 5–32 % of patients. To date, the problem regarding the extent of lymph node dissection in treatment of OC recurrence is still unsolved. In our paper we review the available data concerning the role of secondary cytoreductive surgery for isolated lymph node recurrence of ovarian cancer.Conclusion. Isolated lymph node recurrence of ovarian cancer may indicate a more favorable prognosis and has a less aggressive pattern of OC relapse. The role of secondary cytoreduction in this context is not fully understood, but this category of patients may be one of the most suitable for surgical treatment of ovarian cancer recurrence.

Isolated lymph node recurrence in epithelial ovarian cancer: Recurrence with better prognosis?

IntroductionThe aim of this study was to compare overall survival (OS) between women with isolated lymph node recurrence (ILNR) and those with isolated peritoneal localization of recurrence (ICR), in patients managed for epithelial ovarian cancer. MethodsData from 1508 patients with ovarian cancer were collected retrospectively from1 January 2000 to 31 December 2016, from the FRANCOGYN database, pooling data from 11 centres specialized in ovary treatment. Median overall survival was determined using the Kaplan-Meier method. Univariate and multivariate analyses were performed to define prognostic factors of overall survival. Patients included had a first recurrence defined as ILNR or ICR during their follow up. Results79 patients (5.2 %) presented with ILNR, and 247 (16.4 %) patients had isolated carcinomatosis recurrence. Complete lymphadenectomy was performed more frequently in the ILNR group vs. the ICR group (67.1 % vs. 53.4 %, p = 0.004) and the number of pelvic lymph nodes involved was higher (2.4 vs. 1.1, p = 0.008). The number of involved pelvic LN was an independent predictor of ILNR (OR = 1.231, 95 % CI [1.074–1.412], p = 0.0024). The 3-year and 5-year OS rates in the ILNR group were 85.2 % and 53.7 % respectively, compared to 68.1 % and 46.8 % in patients with ICR. There was no significant difference in terms of OS after initial diagnosis (p = 0.18). 3- year and 5-year OS rates after diagnosis of recurrence were 62.6 % and 15.6 % in the ILNR group, and 44 % and 15.7 % in patients with ICR (p = 0.21). ConclusionILNR does not seem to be associated with a better prognosis in terms of OS.

Salvage lymphadenectomy in recurrent ovarian cancer patients: Analysis of clinical outcome and BRCA1/2 gene mutational status

ObjectiveThis study is aimed to analyze the clinical outcome of recurrent ovarian cancer patients bearing isolated lymph-node recurrence (ILNR) who underwent salvage lymphadenectomy (SL). The prognostic role of clinicopathological variables and the mutational status of BRCA1/2 have also been investigated. MethodsThis retrospective, single-institutional study included women with platinum-sensitive lymph node recurrence underwent to SL between June 2008 and June 2018. Univariate and multivariate analysis was performed to evaluate the impact of clinical parameters, and BRCA1/2 mutational status on post salvage lymphadenectomy progression-free survival (PSL-PFS). ResultsAs of June 2019, the median follow-up after SL was 30 months, and the relapse has been documented in 48 (56.5%) patients. In the whole series, the median PSL-PFS was 21 months, and the 3-year PSL-PFS was 36.7%. The median PSL-PFS, according to patients with ILNR (N = 71) versus patients with lymph-nodes and other sites of disease (N = 14), was 27 months versus 12 months, respectively.Univariate analysis of variables conditioning PSL-PFS showed that platinum-free interval (PFI) ≥12 months, normal Ca125 serum levels, and number of metastatic lymph-nodes ≤3 played a statistically significant favorable role. In multivariate analysis, PFI duration ≥12 months and the number of metastatic lymph nodes ≤3 were shown to keep their favorable, independent prognostic value on PSL-PFS. ConclusionsIn the context of SL, the patients with long PFI and low metastatic lymph node numbers at ILNR diagnosis have the best outcome. The BRCA mutational status seems not associated with clinical variables and PSL-PFS, differently from other sites of disease in ROC patients.

Low Rates of in-Field Recurrence with Regional Nodal Salvage Radiation and Temporary Androgen Deprivation for Pelvic and/or Para-Aortic Prostate Cancer Nodal Recurrences Detected By C11 Choline PET/CT Following Primary Therapy

C11 choline PET/CT enables localization of prostate cancer recurrences in patients (pts) with rising prostate-specific antigen (PSA), yet the role of salvage external beam radiotherapy (sEBRT) for isolated lymph node recurrences detected by such imaging remains undefined. We report our clinical outcomes of sEBRT to sub-diaphragmatic lymph node recurrences combined with extended duration androgen deprivation therapy (ADT). Pts who received sEBRT to lymph node recurrences localized with C11 choline PET/CT between 2012 and 2017 were eligible for study. Pts with choline-avid lymph nodes beyond the retroperitoneum, bone metastases, or castrate-resistance were excluded. Clinical outcomes were analyzed separately from time of sEBRT completion, ADT completion, and testosterone recovery > 50 ng/dL using Kaplan-Meier and competing risk methods. Biochemical recurrence was defined as a PSA level >0.2 ng/mL for pts with prior radical prostatectomy (RP) and >2.0 ng/mL for those who received prior definitive EBRT or brachytherapy (BT). Post-sEBRT radiographic recurrence was analyzed with death as a competing risk. In-field recurrences were defined as those occurring within the 50% sEBRT prescription isovolume. 97 pts were identified with median age of 69 years (range 48-84) and median follow up of 3 years. All pts had received either RP (82), EBRT (8), or BT (7), with a rising PSA that prompted choline PET/CT which identified recurrent pelvic and/or para-aortic lymph nodes. sEBRT was delivered with ADT of 12 to 24 month intended duration. Typical sEBRT fields boosted involved nodes to 56.25 Gy in 25 fractions while simultaneously treating adjacent elective regional nodes to 45 Gy. In the 21 post-RP pts without prior salvage RT, the prostatic fossa was treated concurrently (dose range 64.8-72 Gy). At 4 years, overall survival was 98%. Biochemical recurrence rates at 2 and 4 years were 21% (95% CI 13-29%) and 53% (95% CI 35-65%), respectively. Rates of any radiographic recurrence at 2 and 4 years were 7% (95% CI 4-15%) and 25% (95% CI 16-40%): In-field recurrences were 1% (95% CI 0.2-7%) and 6% (95% CI 2-18%), and out-of-field recurrences were 6% (95% CI 3-14%) and 24% (95% CI 15-39%). At last follow up, 47 pts (48%) remained alive without radiographic recurrence or biochemical failure, and, of those, 28 pts (29% of total) were off ADT with testosterone ≥ 50 ng/dL. Choline PET/CT-guided sEBRT incorporating pelvic and para-aortic nodal recurrences and adjacent elective sites with extended duration ADT is associated with low rates of in-field recurrence. Out-of-field distant metastases represent the predominant pattern of failure, supporting the use of ADT-based strategies. Prospective clinical trials evaluating this approach are warranted.

Should an elective neck dissection be performed for maxillary sinus squamous cell carcinoma?

Should an elective neck dissection be performed for maxillary sinus squamous cell carcinoma?

Survival outcomes of ovarian cancer patients treated with secondary cytoreductive surgery for isolated lymph node recurrence: A systematic review of the literature.

Isolated lymph node recurrence (ILNR) is present in 12-37% of recurrences in ovarian cancer patients. Although several studies have investigated the impact of secondary cytoreduction in these cases, consensus still lacks concerning their optimal management. The purpose of the present review is to investigate whether secondary cytoreduction benefits patients with ILNR in terms of overall survival (OS) and post-relapse survival (PRS). The present systematic review was designed using the PRISMA and AMSTAR guidelines and has been registered with PROSPERO (CRD42019122854). We searched Medline, Scopus, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL and Google Scholar databases from inception until February 2019. Overall, eight studies where included that recruited a total number of 479 women. Current evidence suggests that ILNR in EOC patients should be clearly distinguished from recurrences in other sites (including peritoneal and parenchymal) as their course seems to be less aggressive. Furthermore, the implementation of secondary cytoreduction as an adjunct to standard chemotherapy should be taken into consideration in this specific group of patients as the PRS may easily reach and even extend beyond 5 years. Prolonged survival (>110 months) may be seen as a realistic target for a significant number of these patients when systematic lymphadenectomy is performed. The findings of our review suggest that patients with ILNR should be treated with a combined surgical and chemotherapeutic approach to optimize survival outcomes. However, further studies are needed to reach firm conclusions as current evidence is based in low quality studies.

Secondary Cytoreductive Surgery for Patients with Isolated Lymph Node Recurrence of Gynecologic Cancer

Secondary Cytoreductive Surgery for Patients with Isolated Lymph Node Recurrence of Gynecologic Cancer

Salvage Carbon-ion Radiotherapy for Isolated Lymph Node Recurrence Following Curative Resection of Esophageal Cancer.

Evaluation of the therapeutic efficacy of carbon-ion radiation therapy for isolated lymph node recurrence following curative resection of esophageal cancer. Ten cases with lymph node recurrence after esophageal cancer surgery were treated with carbon-ion radiation therapy. A total of 48.0 Gy [relative biologic effectiveness (RBE)] was delivered over 3 weeks with a daily dose of 4.0 Gy (RBE). The median follow-up duration was 27.1 months (range=3-92.0 months) after carbon-ion radiation therapy. The local control rates at 2, 3 and 5 years were 92.4%. The overall survival rates at 2, 3 and 5 years were 70.0%, 58.3% and 21.9%. The median survival period was 45.3 months after carbon-ion radiation therapy. There were no toxicities of grade 3 or higher. Carbon-ion radiation therapy may be a safe and effective treatment option for isolated lymph node recurrence after radical surgery for esophageal cancer.

Can Early Dissection of Cervical Lymph Nodes Improve Prognosis in Squamous Cell Carcinomas of the Hard Palate

Squamous cell carcinomas of the hard palate and maxillary alveolar ridge are rare tumours with a poor prognosis. Lymph node dissection is recommended for tumours with nodal involvement, and is rarely performed in the absence of adenopathy. We report a series of patients with squamous cell carcinomas and evaluate the rate of lymph node invasion and its impact on survival. This is a retrospective study of 72 patients treated for squamous cell carcinoma of the hard palate and maxillary alveolar ridge between January 1, 1998 and December 31, 2008 in two cancer centres. Using clinical and radiological assessment, tumours were classified as T1-T2 in 25 patients (34.7%) and T3-T4 in 47 patients (65.3%). At diagnosis, 16 (22.2%) patients had clinical and/or radiological nodal involvement and 7 patients (9.7%) distal metastasis. Among N0 patients, 13 (18%) experienced isolated lymph node recurrence. Two-year global survival was 60%; 5-year survival was 34%. The rate of lymph node invasion observed in squamous cell carcinoma of the hard palate and maxillary alveolar ridge does not differ from other oral cavity sites. Because nodal recurrence worsens the prognosis of such a patient, lymph node dissection should be considered at an early stage, even among N0 patients.

A Rare Case Report: Isolated Mediastinal Lymph Node Recurrence in High-Risk Endometrial Cancer at 5 Years after Primary Laparoscopic Surgery

Endometrial cancer is the most common malignancy in some developed countries, with an estimated 102 423 new cases reported in 2015. Isolated mediastinal lymph node recurrence has not been reported previously in this setting. We report a 78-year-old woman with an isolated lymph node recurrence in the mediastinal aortic region detected 5 years after her initial surgical treatment and postoperative adjuvant chemotherapy. Following curative radiotherapy with volumetric-modulated arc therapy at 60 Gy, the recurrence disappeared. To our knowledge, this is the first reported case of recurrent endometrial cancer with isolated mediastinal recurrence.

The outcome and prognostic factors for lymph node recurrence after node-sparing definitive external beam radiotherapy for localized prostate cancer.

BackgroundThe prognostic factors for the recurrence of lymph node (LN) metastasis after dose-escalated radiotherapy (RT) in prostate cancer patients have not been well investigated. We report the prognostic factors and outcomes in patients receiving salvage treatment for LN recurrence after high-dose intensity-modulated RT (IMRT).MethodsWe studied a cohort of 419 patients with localized prostate adenocarcinoma undergoing definitive IMRT (78 Gy). LN recurrence was diagnosed by size criteria using computed tomography (CT) or magnetic resonance imaging, or abnormal uptake of 18F-fluorocholine by LNs on positron emission tomography/CT. Overall survival and LN recurrence-free survival (LNRFS) were calculated, and prognostic factors were evaluated.ResultsWith a median follow-up of 60 months, 18 patients (4.3 %) had LN recurrence and a significantly lower 5-year overall survival rate (60 vs. 90 %, p = 0.003). Univariate analysis showed that T3/T4 stage (p = 0.003), Gleason score >7 (p < 0.001), and estimated risk of pelvic LN involvement of >30 % by the Roach formula (p = 0.029) were associated with significantly lower LNRFS. On multivariate analysis, high Gleason score (hazard ratio = 5.99, p = 0.007) was the only independent factor. The 1/2-year overall survivals after LN recurrence were 67/54 %. Patients with isolated LN recurrence (p = 0.003), prostate-specific antigen (PSA) doubling time >5 months (p = 0.009), interval between PSA nadir and biochemical failure >12 months (p = 0.035), and PSA <10 ng/ml at LN recurrence (p = 0.003) had significantly better survival. Patients with isolated LN recurrence had significantly better survival when treated with combined RT and hormones than when treated with hormones alone (p = 0.011).ConclusionsGleason score of >7 may predict LN recurrence in prostate cancer patients treated with definitive IMRT. Small number of patients limits the extrapolation of this risk with the primary treatment strategy. Combined RT and hormones may prolong survival in patients with isolated LN recurrence.

Contact x-ray brachytherapy 50 kV (CXB) for organ preservation in T2 T3a-b rectal cancer: Lyon-Nice experience in 120 patients.

676 Background: Organ preservation (avoiding TME surgery) for T2 T3 a-b rectal cancer is a field of active clinical research. Contact X Ray CXB combined with external beam radiotherapy (EBRT) ± concurrent chemotherapy (CRT) is an attractive method to achieve clinical complete response (cCR) and consequently rectal preservation. We report an overview of 120 patients treated with CXB+EBRT over a 25 year period in Lyon since 1986 and then in Nice until 2012. Methods: Between 1986 and 2012, 120 patients presenting rectal adenocarcinoma T2 T3a-b (distal rectum: 87; middle rectum: 33) were treated with CXB +EBRT with conservative intent. In Lyon (1986-2001), 80 patients median age: 73y; T2:52; T3:28) risk were treated using CXB (80-110 Gy/3-4 fr/4-6 weeks) followed by EBRT (39 Gy/13 fr/18 days) and 192 Iridium implant boost (20 Gy). When cCR was achieved, close surveillance was proposed. In Nice (2002-2012), 40 patients (median age 81y; T2:22; T3:18) received CXB same regimen as in Lyon (using new Papillon 50 machine since 2009) + EBRT (45-50 Gy/5weeks) with concurrent chemotherapy (5-FU or Capecitabine). When cCR was achieved close surveillance was proposed or local excision (13 pts). Results: Median follow-up time 58 months in both groups. Local relapse occurred mainly in the 2 first years. Isolated lymph node recurrence &lt;5%. Bowel function good or excellent when rectum preserved. Main clinical outcomes in table (some improved results in Nice possibly due to better treatment approach and patient selection). Conclusions: CXB with EBRT and concurrent capecitabine achieve safely high rate of cCR with organ preservation. The OPERA randomized trial will reproduce Lyon R 96 trial (Gerard JP, JCO 2004;22:2404) and test the superiority of CXB boost for organ preservation. [Table: see text]

Secondary cytoreductive surgery for isolated lymph node recurrence of epithelial ovarian cancer: A multicenter study

IntroductionChemotherapy is the standard treatment of recurrent epithelial ovarian cancer (EOC), but its use in nodal relapses is still debated. On the other hand, the role of secondary cytoreductive surgery (SCS) remains controversial. Aim of this study is to evaluate feasibility and outcomes of SCS for the specific setting of recurrent ovarian cancer, exclusively relapsing in lymph nodes. Patients and methodsWe conducted a retrospective analysis in five Italian Institutions (University of Torino, INT of Milano, CRO of Aviano, University of Pisa and INT of Napoli) from 2000 to 2012. Patients with EOC who underwent secondary surgery for isolated lymph node recurrence (ILNR) were selected. ResultsSeventy-three patients were identified. At first diagnosis, patients received debulking surgery and platinum-based chemotherapy. The median disease free interval from completion of primary chemotherapy to nodal recurrence was 18 months. Nodal recurrence was para-aortic in 37 patients (50.7%), pelvic in 21 (28.8%), pelvic and para-aortic in 9 (12.3%), pelvic and inguinal in 3 (4.1%) and inguinal in 3 (4.1%). During SCS, in 1 patients nephrectomy was necessary for renal vein injury. No significant postoperative morbidity occurred. Median follow-up is 50 months. After secondary surgery, 32 (43.8%) are alive without disease, 18 (24.6%) are alive with disease and 23 patients (31.5%) are dead of disease. Five-year overall survival from the time of treatment of recurrent disease is 64%. ConclusionsSecondary surgery for ILNR of ovarian cancer is feasible, safe, with low morbidity and it is associated with a favorable outcome.