Nodal Disease In Patients Research Articles

Management of advanced nodal disease in patients treated with primary chemoradiotherapy.

The management of advanced nodal disease in patients treated with chemoradiotherapy has been a controversial topic for many years. New data have recently been reported, including the results of a multicentre randomized trial making this review timely. The PET-NECK trial showed that PET-computer tomography (CT) surveillance is as effective as planned neck dissection in terms of overall survival, but results in much fewer neck dissections, less complications and is more cost effective. Cost-effectiveness data from a single centre study demonstrated that strategies that include PET-CT were more effective than CT-alone-guided strategies. There is now level 1 evidence to support image-guided surveillance strategies as the standard of care for advanced nodal disease in patients treated with primary chemoradiotherapy.

Sa1462 The Effect of Fiducials on Resection Margin and Nodal Disease in Patients Receiving Neoadjuvant Chemoradiation Therapy for Borderline Resectable Pancreatic Adenocarcinoma

Sa1462 The Effect of Fiducials on Resection Margin and Nodal Disease in Patients Receiving Neoadjuvant Chemoradiation Therapy for Borderline Resectable Pancreatic Adenocarcinoma

Status of the Regional Nodal Basin Remains Highly Prognostic in Melanoma Patients with In-Transit Disease

The role of SLNB for in-transit (IT) melanoma is controversial. The objective of this study was to determine the rate and prognostic significance of occult nodal disease in patients undergoing surgical nodal staging for IT disease. We conducted a retrospective review of patients with IT melanoma from May 2005 through September 2014. Analysis was limited to patients with a first-time IT event who underwent surgical excision. Associations between clinicopathologic characteristics, patterns of recurrence, and survival were analyzed. A total of 261 patients treated at our center were identified and 157 met inclusion criteria, of which 135 (86%) presented with no evidence of nodal disease. At the time of surgical excision of the IT lesion, 80 (58%) clinically node-negative patients underwent observation of the nodal basin and 55 (41%) surgical nodal staging. Twenty (36%) clinically node-negative but surgically staged patients were found to have nodal disease. Distant metastasis-free survival was 70.8 months for surgically staged node-negative patients, 19.2 months for surgically staged node-positive patients, 22.8 months for those staged node-negative by clinical examination only and 4.8 months for those with clinical nodal disease (p= 0.01). The regional nodal basin was the first site of failure in 14 of 66 (21%) clinically staged patients, 5 of 50 (10%) for those surgically staged, and 6 of 16 (38%) for those with clinical nodal disease. Patients with IT disease are at high risk for occult nodal metastasis. Because clinical staging is unreliable, SLNB should be considered. For patients with IT recurrence, the status of the regional basin is strongly prognostic and stratifies patients into low-, intermediate-, and high-risk groups.

Image guided volumetric response during chemoradiotherapy for head and neck squamous cell carcinoma as a predictor of disease outcomes

PurposeThe goal of this study was to correlate volumetric image guided disease response to clinical outcomes in patients receiving chemoradiation therapy (CRT) for locally advanced head and neck squamous cell carcinoma (HNSCC). Materials and methodsThirty four patients completing definitive CRT for locally advanced HNSCC with megavoltage computed tomography (MVCT) guided tomotherapy IMRT were retrospectively reviewed for volumetric response. Grossly identifiable primary tumor (PT) and nodal disease (ND) response was evaluated by weekly MVCT regression. Percent end-of-treatment (EOT) residual volumes and regression rates were correlated with risk of local failure (LF), progression free survival (PFS), and overall survival (OS). ResultsA total of 7 LFs were identified in 6 patients at a median follow-up of 8months. The mean percent EOT residual volumes for PT and ND in patients with and without LF were 20% vs. 5% (p=0.005) and 47% vs. 6% (p=0.0001), respectively. The PT and ND volume regression rates for patients with and without LF were 12.7% per week vs. 15.9% per week (p=0.04) and 3.4% per week vs. 10.5% per week (p<0.001), respectively. Utilizing an EOT cut-off value of 25% residual volume, the relative risks of LF for PT and ND were 14.7 (p=0.03) and 25 (p=0.001), respectively. Patients found with PT and/or ND residual volumes <25% at EOT had longer 2year OS of 100% vs. 67% (p=0.0023) and PFS of 87% vs. 17% (p<0.001) compared with patients with residual volumes >/= 25% at EOT. ConclusionPatients with locally advanced HNSCC who have significant MVCT volume reduction over the course of definitive CRT tend to have favorable clinical outcomes.

Contemporary Management of Recurrent Nodal Disease in Differentiated Thyroid Carcinoma.

Differentiated thyroid carcinoma (DTC) comprises over 90% of thyroid tumors and includes papillary and follicular carcinomas. Patients with DTC have an excellent prognosis, with a 10-year survival rate of over 90%. However, the risk of recurrent tumor ranges between 5% and 30% within 10 years of the initial diagnosis. Cervical lymph node disease accounts for the majority of recurrences and in most cases is detected during follow-up by ultrasound or elevated levels of serum thyroglobulin. Recurrent disease is accompanied by increased morbidity. The mainstay of treatment of nodal recurrence is surgical management. We provide an overview of the literature addressing surgical management of recurrent or persistent lymph node disease in patients with DTC.

Imaging strategy for response evaluation to chemoradiotherapy of the nodal disease in patients with head and neck squamous cell carcinoma.

Definitive chemoradiotherapy (CRT) is used to treat lymph node metastatic head and neck cancer patients. Regional control of the neck disease is important to improve the prognosis, and the accuracy of the method used to evaluate the metastatic lymph node(s) after CRT is crucial to the decision-making process for any following salvage surgery. Patients undergoing CRT were divided in two groups of patients of those showing complete clinical response (CR) and those showing clinical non-response (non-CR), as assessed by computed tomography (CT) and/or magnetic resonance imaging (MRI), ultrasonography, fluorodeoxyglucose-positron emission tomography (FDG-PET), and fine needle aspiration cytology. The responses (CR vs. non-CR) were compared with the actual clinical outcomes. For the interim analysis, the study period was broken down into two periods, namely, the exploratory phase (patients treated between January 2002 and April 2012) and the validating phase (patients treated between May 2012 and January 2014). The sensitivity, specificity, and accuracy were as follows: CT and/or MRI, 66.7, 73.8, and 72.8%, respectively, in the exploratory phase; ultrasonography, 91.7, 70.6, and 73.4%, respectively, in the exploratory phase and 80.0, 82.8, and 82.4%, respectively, in the validating phase; FDG-PET, 50.0, 97.5, and 91.3%, respectively, in the exploratory phase and 60.0, 100, and 94.1%, respectively, in the validating phase; cytology, 68.4, 95.9, and 90.3%, respectively, in the exploratory phase and 66.7, 100, and 85.7%, respectively, in the validating phase. Based on our results, CT and/or MRI appear to be inadequate methods for the evaluation of the response of lymph node(s) to CRT. In contrast, ultrasonography appears to be a highly sensitive and useful tool for positive screening at 6-8weeks after CRT, and FDG-PET appears to be a highly specific and useful tool for negative screening at 8-12weeks after CRT.

Occult metastases in node-negative breast cancer: A Surveillance, Epidemiology, and End Results−based analysis

The role of immunohistochemistry (IHC) for detecting occult lymph node disease in patients initially found to be node-negative by routine pathology is controversial. In this study, we evaluated trends associated with overall survival in node-negative breast cancer patients staged by IHC. The Surveillance, Epidemiology, and End Results database was queried for all patients with invasive breast adenocarcinoma and negative lymph nodes on routine pathology between 2004 and 2011 who underwent IHC to evaluate for occult nodal disease. Overall survival stratified by N-stage was compared with Kaplan-Meier analysis. Multivariate analysis was performed using a Cox proportional hazards model. Overall, 93,070 patients were identified, including 4,657 patients with isolated tumor cells (<0.2 mm diameter or <200 cells) and 6,720 patients with micrometastases (0.2-2 mm diameter). Kaplan-Meier curves demonstrated a difference in overall survival across all groups (P < .0001). On multivariate analysis, micrometastases remained an independent predictor for survival compared with IHC-negative patients (hazard ratio 1.40, 95% confidence interval 1.28-1.53), whereas isolated tumor cells were not a significant predictor (hazard ratio 1.05, 95% confidence interval 0.92-1.20). Patients with occult micrometastases in axillary lymph nodes found via IHC demonstrated a significant overall survival difference, but isolated tumor cells have no prognostic significance.

Early toxicity outcomes: A single 15Gy fraction HDR brachytherapy as pre-treatment EBRT boost in prostate cancer

Purpose/Objectivel: Targeted intraoperative radiation therapy (IORT) as an alternative to whole breast irradiation has been described for patients with early-stage breast cancer. The randomized phase III TARGiT trial demonstrated similar recurrence rates to WBI and a lower overall toxicity profile on short-term follow-up. We report on our early Latin American surgical experience using the Intrabeam radiotherapy delivery system. Materials and Methods: Prospectively gathered estrogen receptor-positive, clinically node-negative patients with invasive breast cancer < 2.5 cm receiving using the Intrabeam system were reviewed. IORT-related effects and early postoperative outcome were assessed. Results: Seventy eight patients (median age 67 years) underwent lumpectomy, sentinel lymph node biopsy, and concurrent IORT from march 2013 to march 2014. Ninety-five percent of patients had invasive ductal histology with a median tumor size of 1.5 cm. Conclusions: While a variety of APBI techniques are currently available for clinical use, our early Latin American operative experience with IORT shows it is well tolerated with low morbidity. The addition of WBI may be necessary in situations for positive residual margins or microscopic nodal disease in patients who do not undergo additional surgery. Implementation of IB impacts treatment planning and operating room use in a multidisciplinary breast cancer program. The safety profile, ease of administration, and reduced costs of IB favor its more widespread use in selected patients with early-stage breast cancer.

Management of recurrent/persistent nodal disease in patients with differentiated thyroid cancer: a critical review of the risks and benefits of surgical intervention versus active surveillance.

The primary goals of this interdisciplinary consensus statement are to define the eligibility criteria for management of recurrent and persistent cervical nodal disease in patients with differentiated thyroid cancer (DTC) and to review the risks and benefits of surgical intervention versus active surveillance. A writing group was convened by the Surgical Affairs Committee of the American Thyroid Association and was tasked with identifying the important clinical elements to consider when managing recurrent/persistent nodal disease in patients with DTC based on the available evidence in the literature and the group's collective experience. The decision on how best to manage individual patients with suspected recurrent/persistent nodal disease is challenging and requires the consideration of a significant number of variables outlined by the members of the interdisciplinary team. Here we report on the consensus opinions that were reached by the writing group regarding the technical and clinical issues encountered in this patient population. Identification of recurrent/persistent disease requires a team decision-making process that includes the patient and physicians as to what, if any, intervention should be performed to best control the disease while minimizing morbidity. Several management principles and variables involved in the decision making for surgery versus active surveillance were developed that should be taken into account when deciding how best to manage a patient with DTC and suspected recurrent or persistent cervical nodal disease.

Occult Nodal Disease in Patients With Non–Small-Cell Lung Cancer Who are Suitable for Stereotactic Ablative Body Radiation

IntroductionStereotactic ablative body radiotherapy is a therapeutic option for patients with peripheral stage I NSCLC in whom surgical resection is considered high risk. Patients receiving SABR do not undergo systematic nodal dissection and any occult nodal metastases will therefore go undetected. Our aim was to determine what proportion of cases this might represent. Materials and MethodsWe retrospectively studied patients who underwent lung resections for presumed stage I NSCLC between 2008 and 2011 at a United Kingdom teaching hospital. We reviewed postoperative pathological lymph node staging and analyzed a subset of these patients in whom SABR would have been be technically possible. ResultsWe reviewed 128 cases of presumed NSCLC preoperatively staged as T1/2a N0 M0. Of 89 cases with peripheral tumor location, 8 patients (8.9%) had nodal involvement at surgical resection. ConclusionOur data show that approximately 1 in 11 patients with peripheral stage I NSCLC will have occult mediastinal/hilar nodal involvement. Although this is a relatively small proportion, routine use of EBUS-TBNA for nodal staging in patients undergoing SABR might identify a greater proportion of patients with nodal disease compared with a strategy of nodal staging directed according to positron emission tomography-computed tomography findings.

Prognostic Value of FDG PET Imaging in Patients with Laryngeal Cancer

Background and PurposeTo investigate the prognostic value of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in patients with laryngeal cancer.Materials and MethodsThe study included 51 patients of whom 30 underwent definitive radiotherapy with or without chemotherapy and 21 underwent radical surgery with or without adjuvant chemoradiation therapy. FDG uptake by both the primary lesion and the neck node was measured using the maximum standardized uptake value (SUVmax). The effects of clinicopathological factors including primary tumor SUVmax and nodal SUVmax on progression-free survival, local control, nodal progression-free survival, and distant metastasis-free survival were evaluated using the log-rank test and Cox method.ResultsThe median duration of follow-up was 48.6 months (range 8 to 82.1 months). Univariate analysis showed that nodal SUVmax, N status, and tumor TNM stage were significantly associated with recurrence, whereas primary tumor SUVmax, age, treatment strategy and T status were not. Multivariate analysis demonstrated that only the nodal SUVmax was a significantly unfavorable factor for progression-free survival (p = 0.029, hazard ratio 0.54, 95% CI 0.38-0.87) and nodal progression-free survival (p = 0.023, hazard ratio 0.51, 95% CI 0.34-0.81). ROC curve analysis and log-rank test showed that patients with a high nodal SUVmax (≧4) had a significantly lower progression-free survival rate than those with a low SUVmax (<4; p<0.0001).ConclusionsThe pretreatment SUVmax of nodal disease in patients with laryngeal cancer is prognostic for recurrence.

Accuracy of ultrasound imaging and ultrasound guided biopsy in the detecting axillary lymph node disease in patients with primary breast cancer

Introduction: Pre-operative ultrasound (US) examination of the axilla and, when indicated, US guided fine needle aspiration (FNA) or core biopsy can be used to assess lymph node status in breast cancer patients. A retrospective audit was performed to compare our results to published data.

264 Removal of limited nodal disease in patients undergoing radical prostatectomy: Long term results confirm a chance for cure

264 Removal of limited nodal disease in patients undergoing radical prostatectomy: Long term results confirm a chance for cure

This Month in Adult Urology

No AccessJournal of UrologyThis Month in Adult Urology1 May 2014This Month in Adult Urology William D. Steers William D. SteersWilliam D. Steers More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.002AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "This Month in Adult Urology." The Journal of Urology, 191(5), pp. 1193–1194 References 1 : Segmental hyperalgesia to mechanical stimulus in interstitial cystitis/bladder pain syndrome: evidence of central sensitization. J Urol2014; 191: 1294. Link, Google Scholar 2 : Removal of limited nodal disease in patients undegoing radical prostatectomy: long-term results confirm a chance for cure. J Urol2014; 191: 1280. Link, Google Scholar 3 : The long-term efficacy of hydrocele treatment with aspiration and sclerotherapy with polidocanol compared to placebo: a prospective, double-blind, randomized study. J Urol2014; 191: 1347. Link, Google Scholar 4 : Outcomes after urethroplasty for radiotherapy induced bulbomembranous urethral stricture disease. J Urol2014; 191: 1307. Link, Google Scholar 5 : 5-year outcome of a randomized prospective study comparing bacillus Calmette-Guérin with epirubicin and interferon-α2b in patients with T1 bladder cancer. J Urol2014; 191: 1244. Link, Google Scholar 6 : The association of lower urinary tract symptoms, depression and suicidal ideation: data from the 2005-2006 and 2007-2008 National Health and Nutrition Examination Survey. J Urol2014; 191: 1333. Link, Google Scholar © 2014 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 191Issue 5May 2014Page: 1193-1194 Advertisement Copyright & Permissions© 2014 by American Urological Association Education and Research, Inc.MetricsAuthor Information William D. Steers More articles by this author Expand All Advertisement Loading ...

Axillary metastasis from an occult tubal serous carcinoma in a patient with ipsilateral breast carcinoma: a potential diagnostic pitfall.

Axillary nodal metastasis from a nonmammary neoplasia is much rarer than diseases associated with a primary breast carcinoma. However, this has to be considered in the differential diagnosis of nodal disease in patients with a history of breast cancer. Here, we report the case of a 73-year-old female with a past medical history of breast cancer, presenting with an ipsilateral axillary metastatic carcinoma. The immunohistochemical profile of the metastatic lesion was consistent with a high grade serous carcinoma. After undergoing a total abdominal hysterectomy and salpingo-oophorectomy, thorough pathological examination revealed two microscopic foci of serous carcinoma in the right fallopian tube, not detectable by preoperative magnetic resonance imaging. In this context, the poorly differentiated appearance of the metastatic tumor and positive staining for estrogen receptor, might lead to a misdiagnosis of metastatic breast carcinoma. As the therapeutic implications differ, it is important for the pathologist to critically assess axillary lymph node metastases, even in patients with a past history of ipsilateral breast carcinoma and no other known primary tumors.

Occult nodal disease in patients with failed laryngeal preservation undergoing surgical salvage

The primary objective was to determine the incidence of pathologically positive lymph nodes in clinically N0 larynx cancer patients undergoing salvage surgery following nonsurgical primary therapy. Secondary aims included assessment of the impact of laryngeal subsite and neck dissection on disease status and survival. Retrospective chart review. Sixty-eight patients with recurrent laryngeal cancer and no evidence of neck disease who underwent salvage laryngectomy and neck dissection after undergoing failed primary radiotherapy or chemoradiation were examined. Main outcome measures included: standard demographics, primary, clinical, radiologic, and pathologic recurrent TNM stage, laryngeal subsite, nodal neck level, surgical intervention, margin status, disease status, survival, and imaging results. Fifty-three men and 15 women, aged 33 to 88 years (mean=62.7 years) with recurrent laryngeal cancer were included. Overall, 28.3% of patients had pathologic nodal disease, with supraglottic cancer showing the highest rate (60%, P=.02). Survival was not associated with laryngectomy type (P=.35). However, on multivariate analysis, laryngeal subsite was significantly predictive of survival with transglottic recurrences demonstrating decreased mean survival (20.7 months, P=.02), and supraglottic recurrences demonstrating prolonged mean survival (37.1 months, P=.03). Metabolic imaging (negative predictive value=0.86) proved more reliable than anatomic imaging (negative predictive value=0.71). The incidence of pathologically positive lymph nodes in clinically negative patients with recurrent laryngeal carcinoma following nonsurgical therapy warrants standard selective neck dissection. Subsite of recurrence, specifically supraglottis and transglottis, correlates with pathologic neck node positivity and survival. Metabolic imaging proved more reliable than anatomic imaging in negative predictability for nodal disease. 4.

Removal of Limited Nodal Disease in Patients Undergoing Radical Prostatectomy: Long-Term Results Confirm a Chance for Cure

In 2003 we reported on the outcomes of 88 patients with node positive disease who underwent radical prostatectomy and pelvic lymph node dissection (median 21 nodes) between 1989 and 1999. Patients with limited nodal disease appeared to have a good chance of long-term survival, even without immediate adjuvant therapy (androgen deprivation therapy and/or radiotherapy). In this study we update the followup in these patients and verify the reported projected probability of survival. The projected 10-year cancer specific survival probability after the initially reported followup of 3.2 years was 60% for these patients with node positive disease. The outcome has been updated after a median followup of 15.6 years. Of the 39 patients with 1 positive node 7 (18%) remained biochemically relapse-free, 11 (28%) showed biochemical relapse only and 21 (54%) experienced clinical progression. Of these 39 patients 22 (57%) never required deferred androgen deprivation therapy and 12 (31%) died of prostate cancer. All patients with 2 (20) or more than 2 (29) positive nodes experienced biochemical relapse and only 5 (10%) of these 49 experienced no clinical progression. Of these 49patients 39 (80%) received deferred androgen deprivation therapy. Biochemical relapse is likely in patients with limited nodal disease after radical prostatectomy and pelvic lymph node dissection, but for 46% of patients this does not imply death from prostate cancer. Patients with 1 positive node have a good (75%) 10-year cancer specific survival probability and a 20% chance of remaining biochemical relapse-free even without immediate adjuvant therapy.

Infradiaphragmatic Hodgkin Lymphoma In Patients Treated With State-Of-The-Art Therapies: A Risk Factor Analysis From The German Hodgkin Study Group (GHSG) HD13 and HD14 Trials

IntroductionThe prognostic impact of isolated infradiaphragmatic Hodgkin Lymphoma (HL) is controversial and no large risk factor analysis in patients treated with state-of-the-art therapies exists. Therefore, we performed a risk factor analysis focusing on isolated infradiaphragmatic nodal disease in patients treated within the German Hodgkin Study Group (GHSG) HD13 (2xABVD vs 2xABV, 2xAVD and 2xAV; followed by 30Gy IFRT each) and HD14 (4xABVD vs 2xBEACOPPescalated plus 2xABVD; followed by 30 Gy IFRT each) trials. MethodsThe characteristics and outcomes of patients with isolated infradiaphragmatic nodal disease qualified for and treated within the HD13 and HD14 trials were compared to patients with supradiaphragmatic nodal disease. Patients with extranodal disease were excluded. Progression-free survival (PFS) and overall survival (OS) were estimated according to the Kaplan-Meier method and compared between groups using the log-rank test. The Cox proportional hazards regression model was applied for multivariate analyses. To assess whether the prognostic impact of infradiaphragmatic disease depends on treatment intensity, patients were divided into groups of less intensive (HD13 arms 2xABV/2xAVD/2xAV and HD14 arm 4xABVD) and more intensive (HD13 arm 2xABVD and HD14 arm 2xBEACOPPescalated plus 2xABVD) chemotherapy, and groups were analyzed separately. All Hazard Ratios (HR) reported for these subgroup analyses were obtained from Cox proportional hazards regression models adjusted for age (HRa). Results1500 and 1403 patients with nodal disease from the HD13 and HD14 trials, respectively, qualified for the analysis. Of those, 139 patients from HD13 (9.3%) and 84 patients from HD14 (6.0%) had isolated infradiaphragmatic disease. Compared to patients with supradiaphragmatic disease, these patients were older (median age 47 vs 35 years, p<0.001), had a WHO index >0 more frequently (22.4 vs 15.2%, p<0.01), and had the subtype of nodular sclerosis less frequently (29.7 vs 55.3%, p<0.001). More patients with infradiaphragmatic disease were male (69.5 vs 52.1%, p<0.001). After a median follow-up of 51 months, PFS was significantly worse in patients with infradiaphragmatic disease (5-year PFS 80.1% vs 91.2%, p<0.001). In a multivariate model adjusted for age and sex, infradiaphragmatic HL remained a significant risk factor in terms of PFS (HR 1.6, 95%-CI [1.2-2.3], p<0.01). However, the inferior PFS could only be observed in the group receiving less intensive chemotherapy (HRa 2.1 [1.4-3.0], p<0.001, figure 1A) whereas there was no difference in patients treated within the more intensive arms (HRa 1.1 [0.5-2.3], p=0.8, figure 1B). Similarly, infradiaphragmatic disease was a significant risk factor for OS when analyzed univariately (5-year OS 91.5 vs 97.6%, p<0.001) and in a multivariate model adjusted for age, trial and WHO index (HR 2.2 [1.3-3.7], p=0.002), but this difference was also restricted to the arms with less intensive chemotherapy (HRa 3.0 [1.7-5.5], p<0.001; more intensive chemotherapy: HRa 1.3 [0.5-3.5], p=0.6). To assess if the current GHSG standard for early favorable HL is sufficient to treat patients with infradiaphragmatic disease, 299 patients who received 2xABVD and 20Gy IFRT within the GHSG HD10 trial were additionally analyzed. The rate of infradiaphragmatic disease was 8.4% (25 patients). In this limited number of patients, there was no PFS or OS difference (HRa 1.0 [0.3-3.2], p=0.95 for PFS; HRa 0.8 [0.1-6.0], p=0.8 for OS). [Display omitted] ConclusionIsolated infradiaphragmatic disease is a risk factor for PFS and OS in HL patients that can be overcome with the current GHSG standard therapies for early favorable (2xABVD followed by 20Gy IFRT) and early unfavorable (2xBEACOPPescalated plus 2xABVD followed by 30Gy IFRT) disease. Disclosures:von Tresckow:Novartis: honoraria for acting as a consultant: Consultancy; Takeda Pharma GmbH: reimbursement of congress, travel, and accommodation costs and honoraria for preparation of scientific educational events: Honoraria. Böll:Celgene: Travel Grant Other. Engert:Seattle Genetics, Inc.: Honoraria, Research Funding; Millennium: Honoraria, Research Funding; Takeda: Honoraria. Borchmann:Millenium The Takeda Oncology Company: Research Funding; Takeda Pharma GmbH: Travel Grants, Travel Grants Other.

P54 Is F-18 FDG PET/CT accurate in detecting nodal disease in patients with suspected lung cancer?

BackgroundAccurate assessment of mediastinal lymph nodes is crucial in determining the management strategies in patients with lung cancer, particularly in those suitable for radical treatment. Positron emission tomography/computed tomography (PET-CT)...

Incidence of Subclinical Nodal Disease at the Time of Salvage Surgery for Locally Recurrent Head and Neck Cancer Initially Treated With Definitive Radiation Therapy

To estimate the incidence of subclinical nodal disease at the time of isolated local recurrence (LR) after chemoradiotherapy for an initially staged N0 head and neck squamous cell carcinoma. We retrospectively reviewed 44 patients who underwent salvage surgery with or without elective neck dissection (END) for an isolated LR between 1997 and 2010. The incidence of subclinical nodal disease was determined from the pathology reports and from clinical neck failures. Thirty patients received END. The overall incidence of subclinical nodal disease in patients with dissected necks was 10% (3/30 patients). The rate of regional control for the 14 observed necks was 100%. Three-year local control and overall survival rates for the END and non-END cohorts were 71% versus 73% (P=0.80) and 55% versus 64%, respectively (P=0.40). The risk of subclinical nodal disease is low for patients with an isolated LR after chemoradiotherapy.