Pelvic Node Research Articles

Oncologic outcome and recurrence patterns of clinical stage IB and IIA cervical cancer: A large retrospective analysis of a tertiary reference center.

Oncologic outcome and recurrence patterns of clinical stage IB and IIA cervical cancer: A large retrospective analysis of a tertiary reference center.

Case Report: A case of uterine embryonal rhabdomyosarcoma in adult female—navigating the complexities of the diagnostic journey

Rhabdomyosarcoma (RMS) is a soft tissue sarcoma originating from primitive mesenchymal cells that exhibit varying degrees of skeletal muscle differentiation. Although RMS predominantly affects children and adolescents—representing one of the most common pediatric solid malignancies—it is exceptionally rare in adults, constituting less than 1% of adult cancers. Due to its embryonic mesenchymal origin, RMS can develop in virtually any organ. In adults, the most common sites are the trunk (27%) and limbs (26%), with the reproductive tract accounting for 17%. Current understanding of adult embryonal RMS primarily relies on case reports, as it is often misdiagnosed as other benign or malignant solid tumors. Here, we report a case of botryoid RMS of the uterine cervix in an adult woman. The diagnostic process was prolonged; after five visits and four biopsies, the diagnosis of rhabdomyosarcoma was finally confirmed. Based on pathological findings and imaging examinations, the clinical stage was determined to be T1N0M0 and Intergroup Rhabdomyosarcoma Study (IRS) IA. The patient was initially scheduled for surgery following neoadjuvant chemotherapy. However, after one cycle of chemotherapy, she experienced massive vaginal bleeding and prolapse of the cervical polypoid mass. Due to significant psychological distress, the patient declined further chemotherapy and insisted on proceeding with surgery. Subsequently, she underwent a robot-assisted laparoscopic radical hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection. A total of six cycles of the VA chemotherapy regimen were administered both pre- and postoperatively. Unfortunately, the 8-month postoperative follow-up results were unfavorable. Less than a year after surgery, contrast-enhanced pelvic MRI revealed enlarged pelvic lymph nodes, suggesting a possible recurrence. The purpose of this study was to report a case of embryonal rhabdomyosarcoma (ERMS) of the uterine cervix in an adult woman and to highlight the diagnostic and therapeutic challenges associated with this condition.

Impact of timing of computed tomography staging and patient factors on the detection of 'true' cN+ bladder cancer.

To evaluate whether computed tomography (CT) scans should be performed before or after transurethral resection of bladder tumour (TURBT) for accurate lymph node staging in clinically lymph node-positive bladder cancer (BCa). Additionally, to identify patient factors that can aid in predicting lymph node metastasis. In this retrospective, multicentre study, we analysed patients with cN+ M0 BCa staged by CT and treated with upfront radical cystectomy (RC) and pelvic lymph node dissection. We stratified patients by the interval between TURBT and CT into three groups: (1) before TURBT; (2) within 30 days after TURBT; and (3) more than 30 days post-TURBT. Staging accuracy, defined as concordance between clinical and pathological lymph node status, was evaluated. We utilised logistic regression analyses to identify patient factors, including the optimal timing of staging, in predicting pathological lymph node status at RC. Among 183 patients with cN+ disease, 90 (49%) had pN0 disease at RC. Of these, 40, 36 and 14 were staged before TURBT, within 30 days after TURBT, and more than 30 days post-TURBT, respectively (P = 0.2). Pathological downstaging was most common in cN1 (22%) and cN2 (20%) disease. The overall concordance rate was 23%. The timing of staging did not correlate with pathological lymph node status on logistic regression (all P > 0.05). Lymphovascular invasion (LVI) at TURBT was associated with pN status (odds ratio 4.25, confidence interval 2.02-9.34; P < 0.001) at RC. Overall, we found no association between the timing of CT-based staging and pathological lymph node metastases in cN+ BCa. The data suggest that performing a TURBT prior to staging does not increase the finding of false-positive nodes on imaging. LVI was the only factor at the time of TURBT associated with pathological lymph node metastasis at RC. Limitations include the multicentre retrospective design and the inclusion of only patients with clinically node-positive disease.

A Commentary on "the efficacy of peritoneal flap fixation on symptomatic lymphocele formation following robotic-assisted laparoscopic radical prostatectomy with pelvic lymph node dissection: a systematic review and meta-analysis".

A Commentary on "the efficacy of peritoneal flap fixation on symptomatic lymphocele formation following robotic-assisted laparoscopic radical prostatectomy with pelvic lymph node dissection: a systematic review and meta-analysis".

Treatment of biochemical recurrence after primary therapy with curative intent

Purpose of review We aimed to summarize the recent advancements in management of biochemical recurrence (BCR) after primary curative therapy for prostate cancer (PCa), and the role of advanced imaging technologies in guiding and improving treatment decisions. Recent findings Recent studies have reshaped the approach to managing BCR after primary treatment for PCa. A key shift is the preference for early salvage radiotherapy (sRT), which has proven to offer comparable or even superior outcomes to immediate adjuvant therapy when closely monitored for progression. PSA kinetics (PSA doubling time) continue to guide treatment decisions, together with the time to PSA rise, Gleason Grade of the original tumor, and PSMA-PET imaging at the time of recurrence. While PSMA-PET significantly enhances the precision of recurrence detection, its sensitivity for smaller pelvic lymph node metastases remains limited, underscoring the need for careful consideration of all factors together to develop a risk-based consulting for all individualized treatment plan integrating patient wishes and health. Summary Recent studies underscore the efficacy of early sRT in managing BCR, with PSA kinetics and ISUP score as a crucial factor in guiding treatment decisions. Furthermore, the integration of PSMA-PET imaging has improved the precision of recurrence detection, facilitating more tailored and effective treatment strategies for patients with BCR. We are finally entering the age of personalized, risk-based, patient-centred case delivery, where treatment of the primary tumor with curative intent is offered to patients with BCR.

Elderly patients undergoing laparoscopic radical cystectomy benefit from dynamic D-dimer measurement in combination with vascular ultrasonography: reduction of VTE risk and improvement of clinical outcomes

BackgroundVenous thromboembolism (VTE) is serious in elderly patients undergoing laparoscopic radical cystectomy and bilateral pelvic lymph node dissection. We compared the results of two VTE prophylaxis protocols: dynamic D-dimer measurement in combination with ultrasonography screening in Experimental Group (EG), and conventional VTE prophylaxis in historical control group (HCG).MethodsBetween January 2022 and January 2024, the elderly patients undergoing such surgeries in EG received dynamic measurement of plasma D-dimer at admission and at 1, 3, 7, and 14 days after surgery in combination with ultrasonography screening, and commensurate VTE mechanical prophylaxis measures. Between January 2019 and December 2021, elderly patients in HCG underwent conventional prophylaxis and mechanical measures. And they were observed carefully for VTE symptoms, with Doppler ultrasonography being performed only in patients with clinical suspicion for VTE. The incidence of VTE event, major postoperative complications, major bleeding rate, and evaluation of activities of daily living within 30 days postoperatively were compared.ResultsThe preoperative and intraoperative parameters were similar between the two groups. In EG, dynamic D-dimer measurements revealed a distinct temporal declining pattern. In HCG, VTE was detected in five patients out of 98 patients (5/98, 4.08%); and in EG, eight patients were found to have DVT (8/109, 7.34%; p = 0.04). The incidence of symptomatic VTE was significantly lower in EG than in HCG (one and five cases, respectively, 0.9% vs. 5.1%, p = 0.04), and the incidence of postoperative asymptomatic VTE was higher in the EG than in the HCG (seven and 0 cases, respectively, 6.4% vs. 0%). The incidence of major complications was similar between the two groups (p = 0.61), with similar result regarding the incidence of major bleeding (p = 0.55). The average Barthel index score in EG was 81.0 points, significantly higher than 78.3 points of the HCG (p = 0.03), and the result demonstrated a faster recovery of activities of daily living in the Experimental Group.ConclusionOur results demonstrated that postoperative dynamic D-dimer and ultrasonography measurement in elderly patients can better monitor the risk of VTE, identify asymptomatic thrombosis at an early stage, optimize the timing of intervention and improve clinical outcomes, without resulting in more complications or major bleeding. Elderly patients undergoing laparoscopic radical cystectomy could benefit from such strategies.

Rationality of FIGO 2018 IIIC cervical cancer according to local tumor and pelvic lymph node metastatic extent–a cohort study

PurposeThere is still controversy for FIGO 2018 stage IIIC. In order to better manage patients with stage IIIC. This study explored the prognostic performance of Stage IIIC patients according to the 2018 FIGO staging system.MethodsCervical cancer patients who underwent radical surgery or chemo-radiotherapy at our institute between June 2011 and June 2021 were retrospectively enrolled. Patients before year 2018 were re-staged according to the 2018 FIGO staging principle. Survival outcome was analyzed by Kaplan-Meier curves and compared using Log-rank method. The best cut-off values for the number of positive lymph nodes and the positive lymph node ratio (LNR) were obtained using X-tile software V3.6.1. The Cox proportional hazard regression model was used for multi-variable analysis.ResultsA total of 2553 cervical cancer patients were enrolled initially. Finally, 443 patients classified as 2018 FIGO stage III were included in the survival analysis.The 5-year disease-free survival (DFS) and 5-year overall survival (OS) of patients with stage IIIC2 were significantly poor than stage IIIA, IIIB and IIIC1, while IIIC1 patients had similar prognosis to IIIA/IIIB. For stage IIIC1 patients (n = 233), multivariate analysis showed that tumor size > 4 cm (DFS: HR 2.472, P < 0.001; OS: HR 2.368, P = 0.002) and poorly-differentiated histology (DFS: HR 2.158, P = 0.002; OS: HR 2.410, P = 0.002) were independent prognostic factors for reduced DFS and OS. In a subgroup analysis of IIIC1p women, tumor size > 4 cm (DFS: HR 2.658, P = 0.023; OS: HR 2.785, P = 0.039) and the number of positive pelvic lymph nodes(pLN) > 3 (DFS: HR 4.829, P < 0.001; OS: HR 5.614, P < 0.001) were found to be independent risk factors for reduced DFS and OS. Combining the local tumor size (TS) and pLN, patients with TS ≤ 4 cm + pLN ≤ 3 revealed significantly better 5-year DFS (89.2%) and 5-year OS (94.9%) than those with TS ≤ 4 cm + pLN > 3 and TS > 4 cm (P < 0.001). Moreover, stage IIIC1p patients with TS ≤ 4 cm + pLN ≤ 3 showed better DFS (P = 0.002) and OS (P = 0.001) than women with stage IIIA and IIIB.ConclusionThe survival outcomes for stage IIIC1 had similar prognosis for stage IIIA or IIIB in the current study. Patients with stage IIIC1p showed variable prognoses dependent on local tumor size and the extent of pelvic lymph node metastases. Therefore, the existing staging criteria might be further improved to provide better guidance for individualized treatment.

Extracellular vesicle-mediated transmission of circPDLIM5 promotes lymphatic metastasis in prostate cancer

For patients with prostate cancer (PCa), pelvic lymph node (LN) metastasis remains a major poor prognostic factor associated with cancer-specific mortality. VEGF-C is a major lymphangiogenic ligand that plays a vital role in LN metastasis in PCa. However, in some PCa caseswith LN metastasis,VEGF-C is not upregulated, indicating that some VEGF-C-independent mechanisms are essential for lymphangiogenesis.Herein, we confirmed that extracellular vesicles (EVs) derived from PCa cells could promote LN metastasis in PCa independent of VEGF-C. We identified an EV circular RNA, circPDLIM5, that could promote lymphangiogenesis and lymphatic metastasis in both PCa cell lines and mouse models. Mechanistically, the packaging of circPDLIM5 into EVs was regulated by heterogeneous nuclear ribonucleoprotein A2B1. Subsequently, EVs were transmitted to human lymphatic endothelial cells, and EVs carrying circPDLIM5 could then directly interact with the transcription factor Yin Yang 1 to enhance the expression of Prospero homeobox 1, which is crucial for the formation, differentiation, and maturation of lymphatic vessels. Our findingshighlight the importance of a molecular mechanism mediated by EVs carrying circPDLIM5that is involved in lymphangiogenesis and LN metastasis in PCa; as a result, EVscarrying circPDLIM5 may be an attractive therapeutic target for LN-metastatic PCa.

Collimator angle selection for prostate and lymph node volumes on the Varian halcyon machine.

Collimator angle selection for prostate and lymph node volumes on the Varian halcyon machine.

Topographic mapping of pelvic and aortic lymph node metastases in stage IIIC1r locally advanced cervical cancer: A retrospective study by the Spain-GOG group.

Topographic mapping of pelvic and aortic lymph node metastases in stage IIIC1r locally advanced cervical cancer: A retrospective study by the Spain-GOG group.

First experiences with an adaptive pelvic radiotherapy system: Analysis of treatment times and learning curve.

First experiences with an adaptive pelvic radiotherapy system: Analysis of treatment times and learning curve.

Primary squamous cell carcinoma of the uterine wall associated with adenomyosis: A rare case report and literature review.

Primary squamous cell carcinoma of the uterine wall associated with adenomyosis: A rare case report and literature review.

Low-dose Apalutamide in Non-metastatic Castration-resistant Prostate Cancer: A Case Series.

Apalutamide is an androgen receptor (AR) inhibitor that has been approved for prostate cancer; however, its minimal effective dose remains unclear. This study aimed to evaluate the outcomes of low-dose apalutamide in patients with non-metastatic castration-resistant prostate cancer (nmCRPC). We conducted a retrospective chart review of patients with nmCRPC, who received ≤60 mg/day of apalutamide. Inclusion criteria were histologically confirmed prostate cancer, rising prostate-specific antigen (PSA) levels without distant metastasis at imaging, testosterone levels <0.50 mg/ml, and consent to data-sharing. The treatment start date was defined as the first dose of apalutamide treatment. PSA response was defined as a >50% decrease at week 12. Results were matched to data from a phase 1 dose-escalation study (ARN-509-001). Six patients were identified (mean age 81.1 years; range=69.6-95.0). Mean PSA level was 14.3 ng/ml (range=5.1-20.7) with a doubling time of 12.7 months (range=2.1-29.6). Disease was confined to prostate only (n=4) and prostate and pelvic nodes (n=2). ECOG performance statuses were 2 (n=2) and 0-1 (n=4). All patients showed a decrease in PSA levels at 12 weeks (binomial test, p=0.031). The time to 50% PSA decrease was 21.6 days (range=11.5-53.5). The median follow-up was 2.44 years. Five of the 6 patients were alive: 2 with undetectable PSA levels, 2 with stable disease, and 1 with an increasing PSA level that remained <2 ng/ml at 3.2 years. This data matched the dose-escalation data (ARN-509-001) that revealed 2/3 responses in patients receiving 60-90 mg/day of apalutamide. Low-dose apalutamide was effective in this 6-patient case series. While awaiting new dose-response studies, we propose an apalutamide dose prescription flowchart that can be adapted for individual patients to avoid exposure to higher doses of the drug.

Adequate pelvic lymph node dissection during radical cystectomy for muscle-invasive carcinoma urinary bladder: A systematic review and meta-analysis of randomized controlled trials comparing extended and limited lymph node dissection

Introduction: To compare the efficacy and safety of extended lymph node dissection (eLND) versus standard LND (sLND) in patients with bladder cancer undergoing radical cystectomy, focusing on overall survival (OS), recurrence-free survival (RFS), and complications, including symptomatic lymphoceles. Materials and Methods: A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched PubMed, MEDLINE, Embase, Scopus, and Cochrane databases for randomized controlled trials (RCTs) comparing eLND and sLND. The primary outcomes were OS and RFS, while secondary outcomes included complications such as lymphoceles, sepsis, and urinary tract infections. Data were extracted independently by two authors, and the risk of bias was assessed using the Cochrane RoB 2 tool. Results: Two RCTs (Gschwend et al., 2019; Lerner et al., 2024) were included, with a total of 1,015 patients. No significant differences were observed in OS (hazard ratio [HR]: 0.95, 95% confidence interval [CI]: 0.66–1.37) or RFS (HR: 1.00, 95% CI: 0.77–1.29) between the eLND and sLND groups. However, eLND was associated with a significantly higher incidence of symptomatic lymphoceles (risk ratio: 2.21, 95% CI 1.13–4.34) and no other major complications. The risk of publication bias was high due to the limited number of included studies. Conclusion: While eLND did not show a survival benefit over sLND, it was associated with a higher risk of lymphoceles. eLND may be beneficial in patients with higher-risk disease requiring precise staging, but sLND is a viable and less morbid alternative for most patients.

P4 Evaluation of surgical lymph node dissection versus pelvic lymph node irradiation in high-risk prostate cancer treated with external radiation therapy

P4 Evaluation of surgical lymph node dissection versus pelvic lymph node irradiation in high-risk prostate cancer treated with external radiation therapy

Computed Tomography Guided Online Adaptive Stereotactic Body Radiation Therapy for Lymph Node Oligometastases: Impact on Dose to Target and Organs at Risk.

This study investigates the radiation dose in abdominal and pelvic lymph node oligometastases (A-P LN) and gastrointestinal organs (GIOs) of patients undergoing computed tomography (CT) guided online adaptive stereotactic body radiation therapy in a phase 2 study. The study aimed to increase the dose to the target iso-toxically. Patients with oligometastatic A-P LN received 45 Gy in 5 fractions on the CyberKnife. Each patient had 3 plans created using a pretreatment planning CT scan: plan A, standard of care (SOC) plan based on the planning CT; plan B, adaptive plan with GIO contours from a diagnostic CT; plan C, adaptive plan with 45 Gy prescribed to the 80% isodose-line. After a prefraction in-room CT scan, the radiation therapy technologist used a decision tree to select the plan with the highest target coverage without exceeding organs at risk constraints. Dose volume histogram parameters were extracted from the original planning CT, the fraction CT with the selected library plan and the fraction CT with the SOC plan. In total, 52 patients were included, and 55 online adaptive treatments were performed. An adaptive plan was chosen in 58% of fractions and in 78% of the patients and resulted in a significant higher Dmean compared with the planned dose (100.6 biologically effective dose (BED10) vs 95 BED10; P < .001). The GIO D0.5cc was 2.7 Gy EQD23 higher for the SOC plan on the fraction CT compared with the SOC on the original planning CT (P = .009). There was no significant difference in GIO D0.5cc between the SOC plan on the fraction CT and the selected plan on the fraction CT. CT-based online adaptive stereotactic body radiation therapy for A-P LN oligometastases, using a library of plans, led to an adaptive plan selection in the majority of patients. This workflow enabled a mean BED10 5 Gy isotoxic dose escalation to the gross tumor volume.

Elective Regional Nodal Irradiation in Prostate Cancer.

Elective Regional Nodal Irradiation in Prostate Cancer.

Clinical impact of surgical energy device (Caiman®) IN elderly patients with Endometrial Cancer (protocol ID: Cineca).

Clinical impact of surgical energy device (Caiman®) IN elderly patients with Endometrial Cancer (protocol ID: Cineca).

Patterns of Recurrence Following Radiation and ADT for Pathologic Lymph Node-Positive Prostate Cancer: A Multi-institutional Study.

Patterns of Recurrence Following Radiation and ADT for Pathologic Lymph Node-Positive Prostate Cancer: A Multi-institutional Study.

Dose Accumulation for Pelvic Stereotactic Ablative Radiotherapy Reirradiation.

Dose Accumulation for Pelvic Stereotactic Ablative Radiotherapy Reirradiation.