Node Drainage Area Research Articles

A approach of gastric conduit via the anterior of pulmonary hilum route during minimally invasive McKeown esophagectomy

BackgroundThe gastric conduit is the most commonly used replacement organ for reconstruction after minimally invasive McKeown esophagectomy. Although the optimal route of gastric conduit remains controversial, the posterior mediastinal route is physiologically preferable but is not without disadvantages. Here, we report the safety and efficacy of a method of gastric conduit reconstruction via the anterior of the pulmonary hilum route.MethodsWe have used the anterior of the pulmonary hilum route since 2021. This procedure involves pulling the gastric conduit up through a substernal tunnel between the right thoracic cavity and the abdominal cavity and passing it into the neck via the anterior of the pulmonary hilum route. In this retrospective study, we compared the clinical outcomes between 20 patients who underwent this procedure and 20 patients who underwent the posterior mediastinal route from 2021 to 2022.ResultsNo mortality was reported in either group. No significant differences were observed between the two groups in duration of surgery, blood loss, incidence of postoperative complications, and postoperative hospital stay. As a result of the anterior of the pulmonary hilum route, the primary tumor bed and lymph node drainage area were effectively bypassed, which facilitates postoperative adjuvant radiotherapy or chemoradiotherapy. The distance of the gastric conduit accompanying the airway was significantly shorter in the anterior of the pulmonary hilum route group.ConclusionsOur method is considered to be a safe and useful technique for the reconstruction of gastric conduit.

Optimization of supraclavicular lymph node clinical target volume delineation in high-risk breast cancer: a single center experience and recommendation

BackgroundProphylactic irradiation of supraclavicular lymph node drainage areas can improve the regional control rate of lymph node-positive or lymph node-negative disease but a locally-advanced stage breast cancer, and it can reduce breast cancer-related mortality. However, many controversies exist in the clinical target volume delineation of supraclavicular lymph node drainage in patients with breast cancer.MethodsWe retrospectively analyzed 42 patients with breast cancer and supraclavicular lymph node metastasis at our hospital between January 2017 and December 2021. Among these cases, 32 were locally advanced and 10 were stage IV at initial treatment. A patient with breast cancer who did not undergo dissection of the supraclavicular and infraclavicular lymph nodes at our hospital was selected as a standard patient. A contrast-enhanced computed tomography (CT) scan for positioning was used as a template image, and blood vessels, muscles, and bony landmarks were used as references for positioning. The metastatic supraclavicular lymph nodes were identified in all enrolled patients and projected into the template CT images.ResultsThe metastastic pattern of supraclavicular lymph node in breast cancer was proposed: distribution along the posterolateral border of the internal jugular vein (medial supraclavicular group) and along the transverse jugular vein (lateral supraclavicular group). We theorized that the lateral and posterior borders of the clinical target volume in the supraclavicular region should include the lymph nodes in the posterior triangle of the neck (level V) in high-risk individuals. If the metastatic axillary lymph node is extensive, then the superior border of the supraclavicular region should be moved upward appropriately.ConclusionsThis study analyzed patients with breast cancer and supraclavicular lymph node metastasis at initial treatment, explored the metastastic pattern of supraclavicular lymph node, and applied anatomical knowledge to further optimize the target volume delineation of supraclavicular lymph node drainage area in high-risk breast cancer.

Progress in the treatment of early gastric cancer with Laparoscopic and endoscopic cooperative surgery

With the introduction of minimally invasive methods into the field of surgery, the concept of early gastric cancer (EGC) treating has gradually changed from the pursuit of standardized traditional surgical methods to precise, individualized, interdisciplinary collaborative management. Both endoscopic therapy and laparoscopic surgery have their limitations for early gastric cancer treatment. Meanwhile, Laparoscopic and endoscopic cooperative surgery (LECS) combines the advantages of endoscopy and laparoscopy to perform local gastric resection and regional lymph node dissection, providing a more effective surgical approach for radical resection of early gastric cancer. The application of LECS in the treatment of early gastric cancer has been increasing, from the initial laparoscopy-assisted endoscopic full-thickness resection to the evolvement of a variety of improved procedures such as combined laparoscopic and endoscopic approach for neoplasia with a non-exposure technique, non-exposed endoscopic wall-inversion surgery, and the possibility of combined (sentinel lymph node drainage area) regional lymph node dissection or sentinel lymph node navigation surgery, which expands the indications for endoscopic surgery and maximizes the preservation of normal gastric tissue structure and function while ensuring radical treatment, and will certainly become an important development direction in the treatment of early gastric cancer in the future.

A retrospective review of non‑intestinal‑type adenocarcinoma of nasal cavity and paranasal sinus.

Non-intestinal adenocarcinoma of nasal cavity and paranasal sinuses (n-ITAC) is a heterogeneous tumor, which has rarely been reported in previous studies. Most high-grade n-ITAC has poor prognosis and there is a lack of classic therapeutic strategy. The present study examined using the PACS system of Nanfang Hospital of Southern Medical University between January 2000 and June 2020. It searched the keyword 'n-ITAC' and selected pathology. A total of 15 consecutive patients were searched. Finally, the present study analyzed a total of 12 n-ITAC patients. The follow-up time was 47 months on average. For low-grade (G1) tumors, 1 and 3-year overall survival (OS) rate were 100 and 85.7% respectively, while for high-grade (G3) tumors, 1 and 3-year OS rates were 80.0 and 20.0% respectively. Pathological grade may be an adverse prognostic factor (P=0.077). The OS of the surgery group was significantly superior to that of the non-surgery group (3-year OS was 63.6 vs. 0%, P=0.0009). Surgery is an indispensable means of treatment. The OS of patients with positive incisal margin was lower compared with that of patients with negative margin (P=0.186), suggesting that complete resection may be one of the prognostic factors. Patients with high risk factors received radiotherapy. The radiation dose was 66-70 Gy/33F for patients with positive margin or non-operation and was 60 Gy/28F for those with negative margin. Most of the patients received prophylactic irradiation of cervical area. Therefore, the prognosis of pathological high-grade n-ITAC is poor. Surgery is the most effective and an indispensable treatment for n-ITAC. For patients with high risk factors, surgery combined with radiotherapy may be a reasonable treatment. With regard to the cover range of radiotherapy, the primary tumor combined with lymph node drainage area is often used in Nanfang Hospital of Southern Medical University and the total dose of radiotherapy can be reduced if the surgical margin is negative.

Retrospective analysis of clinical features and prognosis of nasopharyngeal carcinoma in children and adolescents.

ObjectivesTo investigate the clinical characteristics and prognosis of nasopharyngeal carcinoma (NPC) in children and adolescents in different age groups.Materials and methodsThe clinical data of 51 patients with NPC aged ≤ 18 years who were treated in Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2012 to May 2017 were retrospectively analyzed. The patients were divided into children group (≤12 years old) and adolescent group (12–18 years old) with 12 years old as the boundary. The clinical characteristics, diagnosis, treatment, and prognosis of the children and adolescent groups were compared.ResultsThe symptoms of the first diagnosis in the children group were mainly nasal congestion (P = 0.043) and ear symptoms (P = 0.008). The diagnosis rate of nasopharyngeal biopsy in the children group was lower (P = 0.001), while the rate of diagnosis of cervical mass biopsy was significantly higher than that in the adolescent group (P = 0.009). The proportion of keratinizing squamous cell carcinoma of the children group was higher than that of the adolescent group (P = 0.006). There was no significant difference in TNM stage and risk stratification between the two groups, but the number of cases in the III-IVa children group who received induction chemotherapy + concurrent chemoradiotherapy was less than that in the adolescent group (P = 0.013). The proportion of radiotherapy in the upper and lower cervical lymph node drainage areas was lower than that in the adolescent group (P = 0.001). The percentage of recurrence and metastasis in the children group was higher than that in the adolescent group (P = 0.026).ConclusionThe diagnosis in the children group depended on endoscopic biopsy and neck mass biopsy, and the proportion of keratinizing squamous cell carcinoma was higher. The number of cases of induction chemotherapy and concurrent chemoradiotherapy in the children group was less than that in the adolescent group, and the proportion of radiotherapy in the upper and lower cervical lymph node drainage areas was lower than that in the adolescent group. Clinically, it is necessary to improve the understanding of the clinical characteristics of children with NPC and take appropriate treatment strategies.

Postoperative lymphatic recurrence distribution and delineation of the radiation field in lower thoracic squamous cell esophageal carcinomas: a real-world study

BackgroundTo study lymphatic recurrence distribution after radical surgery in the real world and guide clinical tumor volume delineation for regional lymph nodes during postoperative radiotherapy for lower thoracic squamous cell esophageal carcinomas.MethodsWe enrolled patients who underwent radical esophagectomy, without radiation before or after surgery, at 3 cancer hospitals. Patients were classified into groups according to tumor locations. We included patients with tumors in the lower thoracic segment and analyzed the postoperative lymph node recurrence mode. A cutoff value of 10% was used to differentiate high-risk lymph node drainage areas from others.ResultsWe enrolled 1905 patients in the whole study series, including 652 thoracic esophageal carcinomas that met our inclusion criteria; there were 241 cases of lower thoracic esophageal carcinomas. 1st, 2nd, 4th, 7th, 8th groups of lymph nodes, according to the 8th edition of the AJCC classification, displayed as high-risk recurrence areas, representing 17.8%, 23.9%, 11.7%, 10.9% and 12.2% of lymph node recurrence. Stage III-IV tumors located in the lower segment of the thoracic esophagus showed a tendency to recur in the left gastric nodes (7.9%) and celiac nodes (10.6%).ConclusionsAccording to our results, we recommended including the 4th, 7th and 8th groups of lymph nodes in the radiation field, and for patients with stage III-IV disease, the 17th and 20th groups of nodes should be irradiated during postoperative treatment. Whether including 1st/2nd groups in preventive irradiation needed more proofs.

Chemoradiotherapy and Increased Prescription Dose in Esophageal Squamous Cell Cancer: A Retrospective Study.

To analyze the outcomes and adverse events of patients with esophageal squamous cell carcinoma (ESCC) treated with definitive chemoradiation with modified radiotherapy volume and increased radiation dose. This was a retrospective analysis of patients with ESCC treated with definitive chemoradiotherapy at the Sun Yat-sen University Cancer Center (02/2015 to 02/2017). The dose to the planning gross tumor volume (PGTV) and planning clinical tumor volume (PTV1) was 66-68 Gy (2.0-2.2 Gy/fraction). The dose to the planning regional lymph node drainage area volume (PTV2) was 46 Gy (2.0 Gy/fraction). Treatment response, adverse events, progression-free survival (PFS), overall survival (OS), and locoregional failure-free survival (LRFFS) were analyzed. Twenty-six patients were included. The median follow-up was 31 (range, 4.3-51.3) months. Sixteen (61.5%) patients had a complete response, and four (15.4%) achieved a partial response. The objective response rate was 76.9%, and the disease control rate was 80.8%. The median PFS and OS were not achieved. The 4-year PFS was 63.9%, and the 4-year OS was 71.0%. Grade 1-2 and 3-4 radiation-related esophagitis was observed in 15 (57.7%) and one (4.5%) patients, respectively. Grade 1-2 and 3-4 radiation-related pneumonitis was observed in 12 (46.2%) and one (4.5%) patients, respectively. No patients developed radiation-related heart or skin damage. The modified target volume definition and increased dose of definitive radiotherapy combined with chemotherapy in patients with ESCC had low toxicity and might improve survival, but additional trials are necessary to prove the superiority of this strategy.

Treatment outcomes after definitive radio(chemo)therapy for 17 lacrimal sac squamous cell carcinoma.

Tumors of the lacrimal sac are rare and life-threatening. Because of their rarity, no extensive clinical data on their management and prognosis exist. We investigated the application of definitive radiation therapy and its outcome in patients with lacrimal sac squamous cell carcinoma (LSSCC). We retrospectively studied 17 patients with LSSCC at a single institution between 2003 and 2017. All the patients were treated with definitive radiotherapy, and 11 patients were delivered with cisplatin-based chemotherapy. The patients' clinical records were reviewed for symptoms, pathological types, the volume and dosimetry of the tumors and their adjacent structures, radiation coverage of lymph node drainage areas, treatment outcomes, and complications from definitive radiotherapy. Median follow-up was 38.9 months, and age at diagnosis was 48 years.The 2-year and 5-year overall survival, progression-free survival, locoregional control, and disease metastasis-free survival rates were 94.1 and 84.7%, 88.2 and 73.5%, 93.8%, 94.1, and 78.4%, respectively. A total dose of 6600-7000 cGy was prescribed to the tumor. Levels Ⅰb, Ⅶa, Ⅷ, and Ⅸ were covered with the clinical target volume regardless of lymph involvement. Acute Grade 3 radiation dermatitis occurred in seven patients (17.6%), but no acute Grade 4 or Grade 5 toxicity of any type occurred. Seven (41.2%, 7/17) of the treated eyes had moderated vision impairments; 17.6% (3/17) of patients developed cataracts, and glaucoma and radiation retinopathy were found in 5.9% (1/17) of patients. Definitive radiotherapy could be a treatment option for those who refuse surgery or have unresectable LSSCC. Radiation alone is a treatment option for LSSCC.

Chemoradiation in Periampullary Carcinoma after Whipple’s Pancreatico-duodenectomy

The role of adjuvant chemoradiation in periampullary carcinoma after Whipple’s pancreatico-duodenectomy is not well defined. The aim of this audit was to evaluate the efficacy of adjuvant chemoradiation after Whipple’s pancreatico-duodenectomy in periampullary carcinoma. Between January 1991 to December 2016, the 151 curatively resected patients of periampullary carcinoma were prospectively planned for adjuvant chemoradiation. All patients were planned for adjuvant external beam radiotherapy to a dose of 45-50.4 Gy/ 25-28 fractions in 5-5½ weeks to tumor bed and lymph node drainage area along with either 5-fluorouracil(5-FU) 370mg/m2 I.V. weekly or day 1-5 at 4 weekly or oral Capecitabine 1650mg/m2 daily delivered concurrently during radiation therapy and as adjuvant following completion of radiation therapy. The results were analyzed in October 2019. Of the 151 patients with resected periampullary carcinoma, there were 104 males and 47 females and size of tumor ranges from 0.5 cm to 8 cm(median =2 cm). The median age of patients was 52 years. ; 127 (84 %) were ampullary tumors and 24 (16 %) were non-ampullary including duodenum and distal bile duct. Based on histology and operative findings (such as poorly differentiated histology, positive surgical margin, lymph node positivity and /or pancreatic infiltration) the patients were categorized into high risk group (n= 131, 86.8%) and remaining in low risk group (n=20, 13.2%). The 5-FU chemotherapy (weekly/monthly) was given in 112 patients (74.2%) while oral Capecitabine was given in 20 patients(13.2%) and 19 patients (12.6%) received no chemotherapy and radiation therapy. The median and 5-year overall survival in whole group was 26 months and 26%. According to risk categorization, in low risk group and high-risk group the median survival is 31 vs. 26 months and 5-year Overall is 40% vs. 23.6 % respectively; p-value = 0.19). Among high risk group, 113 patients received chemoradiation and 18 did not. The 5-year OS in this high risk group treated with chemoradiation is 26% vs. 5.6% without RT (p=0.30) and median survival is 27 vs. 21 months respectively. Chemoradiation Toxicities were assessed in all 132 patients who received adjuvant treatment. Two patients died of acute hematological toxicity of chemoradiation during treatment. Local recurrence (37%) followed by distant metastasis to liver and other sites (20.5%) were predominant site of failure and 20% died of other non- specific causes and 4 died of chronic radiation gastroduodenitis with gastrointestinal bleeding with intestinal obstruction, out of them, two had necrosis and perforation of duodenum. Adjuvant chemoradiation is effective and well tolerated in high risk periampullary carcinoma and improves the overall survival, although no significant difference was found between chemoradiation and non chemoradiaion group as number of patients in non RT group were very few.

Dose accumulation in IMRT for left breast cancer determined by applying deformation registration.

BackgroundTo evaluate the dosimetric changes in the target volume and organs at risk (OARs) of patients with left breast cancer (LBC) who underwent intensity-modulated radiation therapy (IMRT) based on a deformation registration (DF) method.MethodsSixteen patients with LBC treated with 6 MV X-ray IMRT were retrospectively analyzed. All targets included the lymph node drainage area and chest wall. All patients underwent CT for simulation of the primary positioning and repositioning. Primary and secondary treatment plans were developed using primary positioning CT (CT1) and repositioning CT (CT2) images to obtain plan1 and plan2, respectively. Rigid and DF of the dose distribution of plan2 to CT1 were applied; the results were then added to the dose distribution of plan1, yielding planrig and plandef, respectively. The dosimetric differences between the target and OAR volumes of the four plans were compared.ResultsThe clinical target volume of CT2 was 8.74% less than that of CT1. The planned target volume of CT2 was 11.20% less than that of CT1. The Dice similarity coefficients (DSCs) of the heart, left lung and right lung were significantly lower after than before DF (0.94±0.01 vs. 0.89±0.05, 0.96±0.01 vs. 0.91±0.03, and 0.96±0.01 vs. 0.92±0.03, respectively; t=3.83, 7.28, and 6.70, P<0.05, respectively). There were no significant differences in the dose-volume indices of the heart or left lung between plan1 and the other plans, while the dose-volume indices were higher in planrig than in plandef.ConclusionsBecause of small changes in the target and OAR volumes during radiotherapy, we suggest the first IMRT plan could be used to evaluate the dose-volume indices of the lungs and heart for these patients.

Clinical efficacy of intensity-modulated radiotherapy in treatment of 66 patients with intermediate risk localized prostate cancer

Objective To evaluate the clinical efficacy and adverse events of intensity-modulated radiotherapy (IMRT) in the treatment of intermediate risk localized prostate cancer, and analyze the significance of prostate-specific antigen (PSA) level changes. Methods Clinical data of 66 patients with intermediate risk localized prostate cancer admitted to our hospital between 2007 and 2018 were retrospectively analyzed. Sixty patients were treated with endocrine therapy before radiotherapy. The radiation field covered the pelvic lymph node drainage area in 6 cases. Forty-seven patients received image-guided radiotherapy (IGRT). The median dose in the prostate and seminal vesicle was 78 Gy and 48 Gy in the pelvic lymph node drainage area. The survival rate was calculated using the Kaplan-Meier method. Results The median age was 77 years. The median follow-up time was 71.3 months. The 5-year sample size was 47. The 3-and 5-year overall survival (OS) was 98% and 90%.The 3-and 5-year cancer-specific survival (CSS) was 100% and 93%.The 3-and 5-year biochemical relapse-free survival was 97% and 86%.The mean time of PSA declining to the nadir was 5.83 months. The median level of PSA nadir was 0.06 ng/ml after IMRT. The incidence of grade I and Ⅱ early adverse events in the urinary system was 38% and 6%. The incidence of grade I and Ⅱ early adverse events in the gastrointestinal system was 21% and 3%. The incidence of grade I and Ⅱ advanced-stage adverse events in the urinary system was 9% and 2%. The incidence of grade I advanced-stage adverse events in the gastrointestinal system was 5%. Conclusions IMRT yields high clinical efficacy in the treatment of intermediate risk localized prostate cancer with a low risk of adverse events in the early and advanced stage. The monitoring of PSA after IMRT contributes to the assessment of clinical prognosis. Key words: Prostate neoplasm/radiotherapy; Treatment outcome; Prostate-specific antigen

Analysis of doses to lymph node drainage areas during involved-field irradiation for esophageal cancer

Objective To analyze the doses to lymph node drainage areas during involved-field irradiation (IFI) in three-dimensional conformal radiotherapy (3DCRT) for esophageal cancer (EC).Methods A retrospective analysis was performed on the clinical data of 81 patients with medically inoperable thoracic EC who received IFI from 2000 to 2004.The lymph node drainage areas were delineated based on the lesions,and the dose-volume parameters of the planning target volume (PTV) of each lymph node drainage area was analyzed.Results The median values of V30,V35,V40,V45,and V50 were 73 ％,70％,67％,64％,and 58％,respectively.The prescribed dose was not significantly correlated with V30 and V35 (P =0.215,0.054),but significantly correlated with V40 and V50 (P =0.027,0.002,0.000) ; the number of radiation fields was not significantly correlated with V30 and V45 (P =0.438,0.535,0.425,0.313),but significantly correlated with V50(P =0.045) ;the length of lesion on barium meal examination and volume of PTV were significantly correlated with V30 and V50 (all P ＜ 0.05).The one-way analysis of variance showed that the Vx value of upper-thoracic segment was greater than those of middle-and lowerthoracic segments (P =0.028,0.045) ; the values of V30 and V35 varied significantly between different lesions,but there were no significant differences in the values of V40 and V50 (P =0.076,0.173,0.695).The Vx value had no significant impact on the long-term survival of patients (all P ＞ 0.05).Conclusions The lymph node drainage areas of EC receive a considerable dose with IFI in 3DCRT,which may play a certain role in preventing regional lymph node metastasis,but more clinical studies are needed. Key words: Esophageal neoplasms/three-dimensional conformal radiotherapy; Involve field irradiation; Lymph node drainage area; Dosimetry

Surgical Management for Carcinoid Tumors of Small Bowel, Appendix, Colon, and Rectum

Carcinoid tumors occur most frequently in the gastrointestinal tract. Despite their ability to produce hormones, most of the midgut and hindgut carcinoids covered in this study are clinically silent, and the diagnosis is often not made before emergency surgery or evaluation for liver metastases. Because the rate of lymph node involvement and the prognosis of carcinoid tumors depend on their site and size, surgery refers to these two factors too. Lymph node metastases are most commonly found with small bowel carcinoids (20-45%), providing the rationale for an extended resection including the adjacent lymph node drainage area. Carcinoid tumors of the appendix < 1 cm in diameter rarely metastasize, simply requiring appendectomy for treatment. Lesions > 2 cm should be treated by right hemicolectomy because of their approximately 30% risk of lymph node metastases. Resection should always be done for carcinoid tumors of the colon resection as for adenocarcinomas. Rectal carcinoids < 2 cm rarely metastasize, directing the conclusion that for these smaller lesions local excision is sufficient; for lesions >2 cm a standard cancer resection should be performed provided distant metastases are absent. In general, the younger the patient or the larger the primary tumor, the more aggressive the treatment should be.

In vivo influences of phorbol ester and calcium ionophore on lymphocyte traffic, lymph flow and efferent lymph levels of thromboxane B2 in sheep

In vitro systems have provided increasing evidence of significant lymphocyte transmembrane signalling by plasma membrane receptors which utilize antigen and other ligand activation of the inositol phosphate dual second messenger system of intracellular signalling. Elevation of intracellular Ca2+ and activation of protein kinase C are important products of these signals and appear to provide a complete set of mitogenic signals for both T and B cells. Calcium inophore and phorbol ester have been found to mimic these events in vitro and are here employed in vitro to study their effects on lymphocyte traffic and efferent lymph flow through primary peripheral lymph nodes of sheep and on the output into efferent lymph of the arachidonic acid metabolite, thromboxane B2. Calcium ionophore and phorbol ester were given alone or in combination to popliteal lymph nodes of sheep by drainage area injection or by acute infusion into cannulated afferent lympatics of study popliteal lymph nodes whose efferent lymphatic was chronically cannulated for study. The findings resembled those of drainage area immunization with an early increase in efferent lymph flow and prompt and marked depressions in the output into efferent lymph of both small recirculating and blast lymphocytes (‘shutdown’,‘recruitment’), followed by a marked increase in the output into efferent lymph of both small recirculating and blast lymphocytes. The greatest elevation in both small recirculating and blast lymphocyte outputs was at 24 and 48 h following phorbol ester and calcium ionophore administration. Acute phorbol ester and calcium ionophore administration was associated with a prompt and marked elevation in efferent lymph levels of thromboxane B2 which were of short duration. The findings observed here with lymph node drainage area infusion/injection of both phorbol ester and calcium ionophore are quite similar to those encountered in this sheep lymphocyte traffic model following popliteal lymph node drainage area immunization with killed Salmonella muenchen antigen.

Localized Deep Hyperthermia Increases the Traffic of Lymphocytes Through Peripheral Lymph Nodes of Sheep In Vivo

The production of localized deep hyperthermia by the radio frequency wave magnetic-loop induction method has been utilized to study the effects of deep hyperthermia on lymphocyte traffic in sheep in vivo. Deep hyperthermia has been applied both to primary peripheral lymph node drainage areas alone (popliteal and prefemoral) and directly over the study lymph node (popliteal). Deep tissue core temperatures were monitored in all studies and the findings were correlated with alterations in the levels of lymphocyte outputs into study node efferent lymph and the volume of efferent lymph flow. In all of 32 studies, there was a prompt and sharp increase in the output of lymphocytes into efferent lymph at 40-43 degrees C. Efferent lymph flow also was increased promptly but to a lesser degree than the output of lymphocytes. The two were not closely correlated. High deep temperature in the nodal area (45 degrees C) appeared to cause delayed nodal malfunction, which depressed lymphocyte output but did not affect lymph flow. Localized deep hyperthermia is an effective and noninvasive means for the local increase of lymphocyte traffic and lymph flow and may prove to be a useful means for the evaluation of the immunological consequences of altering both deep tissue temperature and lymphocyte traffic.

Localized deep hyperthermia increases the traffic of lymphocytes through peripheral lymph nodes of sheep in vivo.

The production of localized deep hyperthermia by the radio frequency wave magnetic-loop induction method has been utilized to study the effects of deep hyperthermia on lymphocyte traffic in sheep in vivo. Deep hyperthermia has been applied both to primary peripheral lymph node drainage areas alone (popliteal and prefemoral) and directly over the study lymph node (popliteal). Deep tissue core temperatures were monitored in all studies and the findings were correlated with alterations in the levels of lymphocyte outputs into study node efferent lymph and the volume of efferent lymph flow. In all of 32 studies, there was a prompt and sharp increase in the output of lymphocytes into efferent lymph at 40-43 degrees C. Efferent lymph flow also was increased promptly but to a lesser degree than the output of lymphocytes. The two were not closely correlated. High deep temperature in the nodal area (45 degrees C) appeared to cause delayed nodal malfunction, which depressed lymphocyte output but did not affect lymph flow. Localized deep hyperthermia is an effective and noninvasive means for the local increase of lymphocyte traffic and lymph flow and may prove to be a useful means for the evaluation of the immunological consequences of altering both deep tissue temperature and lymphocyte traffic.

Lymphocyte traffic effects of systemic and local lidocaine in sheep

The traffic of lymphocytes through lymphoid tissues is of importance in both the initiation and development of the immune response. The effects of lidocaine on lymphocyte traffic through primary peripheral lymph nodes of sheep (popliteal and prefemoral) was investigated by three routes of lidocaine administration. Infiltration of lidocaine above the study node and as the sole anesthetic agent for study node efferent lymphatic cannulation produced mild depressions in lymphocyte outputs into study node efferent lymph. This depression was comparable to that encountered with regional epidural anesthesia for similar operations, but was significantly less than that associated with general anesthesia ( P < 0.000015). In animals with established chronic cannulation of study node efferent lymphatics, both study node drainage area injection of lidocaine and systemic administration of lidocaine (intravenously by bolus injection at a distant site) produced prompt and sharp depressions in lymphocyte traffic as mirrored in the output of lymphocytes into study node efferent lymph. The output of both small recirculating lymphocytes and of blast lymphocytes was affected.

Experience with a new technique for "total node" irradiation--Hodgkin's disease.

Fifty-five patients with Hodgkin's disease, Stages III and IV, were treated by a new technique for total node irradiation. The so-called “3 and 2” method uses two courses of therapy: (1) All lymph-node bearing areas from the tips of the mastoid processes down to the femoral triangles, divided into three segments, are irradiated sequentially to 2,000 rads in four and a half weeks with no rest period between the segments irradiated. (2) After a rest period of three to fourweeks, the same lymphnode drainage areas are divided into two segments, and are irradiated to 1,800–2,000 rads in three and a half weeks. The juncture point is at a level different from the previous two juncture points. This minimizes the risk of overdosage and underdosage where portals abut. It is also often possible to reduce the field sizes, particularly the mediastinal portions, because of shrinkage of the masses during the rest period. The volume of normal tissue irradiated is thus reduced. Treatment was well tolerated. All patients showed complete response with prompt regression of nodes, symptoms and signs, and very little radiation-induced sickness. Blood counts remained within satisfactory limits throughout. There was prompt bone marrow recovery between courses thus avoiding interruptions in treatment.