Supraclavicular Lymph Node Chain Research Articles

Resolution of Pulsatile Tinnitus Following an Upper Mediastinal Lymph Node Resection

External compression of extracranial/mediastinal vessels has not been reported as an etiology of pulsatile tinnitus. We present a case in which compression of extracranial vasculature led to long term pulsatile tinnitus which resolved completely with surgical resection of metastatic lymph nodes. This should be included in the list of differential diagnoses when dealing with any patient with a complaint of pulsatile tinnitus. Patients with advanced carcinoid cancer often present with distant metastases to their left superior mediastinum and supraclavicular lymph node chain. We believe a careful search for nodal metastases compressing vascular structures in such patients is warranted as debilitating pulsatile tinnitus may be cured by a simple surgical procedure.

6N Irradiation of the internal mammary and medial supraclavicular lymph node chain in stage I to III breast cancer: state of the day of EORTC phase III trial 22922/10925 with 4004 patients

Benign prostatic hyperplasia (BPH) is the leading cause of Lower Urinary Tract Symptoms (LUTS) in men worldwide. Urinary frequency, nocturia and incomplete emptying are common symptoms experienced by men with BPH, which significantly reduce their quality of life. Treatment for this dysfunction includes surgical and non-surgical modalities such as watchful waiting, lifestyle modification and medication. Historically, Transurethral Resection of the Prostate (TURP) had been considered the gold standard mainstay of treatment; however, in recent years, minimally invasive techniques which offer similar outcomes, fewer complications and cost-effectiveness have gained popularity. Rezum, is a relatively new minimally invasive modality used to treat BPH which has been recommended for prostate volumes of ≤80 cc. Herein, we present a successful case of managing BPH in a middle-aged patient with a prostate volume of 186 cc.

Toxicity at three years with and without irradiation of the internal mammary and medial supraclavicular lymph node chain in stage I to III breast cancer (EORTC trial 22922/10925)

Introduction. The EORTC 22922/10925 trial investigated the potential survival benefit and toxicity of elective irradiation of the internal mammary and medial supraclavicular (IM-MS) nodes Accrual completed in January 2004 and first results are expected in 2012. We present the toxicity reported until year 3 after treatment. Patients and methods. At each visit, toxicity was reported but severity was not graded routinely. Toxicity rates and performance status (PS) changes at three years were compared by χ2 tests and logistic regression models in all the 3 866 of 4 004 patients eligible to the trial who received the allocated treatment. Results. Only lung (fibrosis; dyspnoea; pneumonitis; any lung toxicities) (4.3% vs. 1.3%; p < 0.0001) but not cardiac toxicity (0.3% vs. 0.4%; p = 0.55) significantly increased with IM-MS treatment. No significant worsening of the PS was observed (p = 0.79), suggesting that treatment-related toxicity does not impair patient's daily activities. Conclusions. IM-MS irradiation seems well tolerated and does not significantly impair WHO PS at three years. A follow-up period of at least 10 years is needed to determine whether cardiac toxicity is increased after radiotherapy.

Quality Assurance in the EORTC Randomized Trial 22922/10925 Investigating the Role of Irradiation of the Internal Mammary and Medial Supraclavicular Lymph Node Chain Works

A quality assurance (QA) program in conjunction with the EORTC trial investigating the role of adjuvant internal mammary and medial supraclavicular irradiation in stage I-III breast cancer is presented. The results of a dummy run procedure and of an individual case review are compared to each other. The effects of recommendations based on QA procedures on the protocol compliance are evaluated. Prior to protocol activation all participating institutes were asked to produce treatment plans according to the guidelines of the protocol based on manual outlines of an average patient. Thereafter, they were asked to provide data on each of their first six randomized patients. The dummy run provided a lot of information on specific treatment techniques. In the individual case review, additional patient- and tumor-related data were collected, showing the use of anatomic information for treatment planning. A comparison between both procedures revealed that the individual case reports concurred more accurately with protocol guidelines than the dummy run. It was observed that the number of systematic protocol deviations was substantially decreased in trial patients compared to the dummy run case. Therefore, it is concluded that this extensive QA program had a positive effect on the consistency of all institutes participating in the trial.

Economic consequence of local control with radiotherapy: Cost analysis of internal mammary and medial supraclavicular lymph node radiotherapy in breast cancer

To investigate the financial implications of radiotherapy (RT) to the internal mammary and medial supraclavicular lymph node chain (IM-MS) in postoperative breast cancer. A cost-effectiveness and cost-utility analysis were performed, using Markov models, comparing the early and delayed costs and effects of IM-MS during a 20-year time span from a societal viewpoint. The outcome estimates were based on Level I evidence from postoperative RT literature and the cost estimates on the standard practice of the Leuven University Hospitals, with the RT costs derived from an activity-based costing program developed in the department. On the basis of the assumptions of the model and seen during a 20-year time span, primary treatment including IM-MS RT results in a cost savings (approximately 10,000) compared with a strategy without RT. Because IM-MS RT also results in better clinical effectiveness and greater quality of life, the treatment with IM-MS dominates the approach without IM-MS. Sensitivity analyses confirmed the robustness of these results in all tested circumstances. Although threshold values were found for the cost of IM-MS, the cost at relapse, and the quality of life after treatment, these were substantially different from the baseline estimates, indicating that it is very unlikely that omitting IM-MS would become superior. This ex-ante cost evaluation of IM-MS RT showed that the upfront costs of locoregional RT are easily compensated for by avoiding the costs of treating locoregional and distant relapse at a later stage. The cost-sparing effect of RT should, however, be evaluated for a sufficiently long time span and is most specifically found in tumors with a rather slow natural history and a multitude of available systemic treatments at relapse, such as breast cancer.

427 Poster Could radiotherapy to the internal mammary and medial supra clavicular lymph node chain (IM-MS) be cost-effective?

427 Poster Could radiotherapy to the internal mammary and medial supra clavicular lymph node chain (IM-MS) be cost-effective?

442 Poster Comparison between two different irradiation techniques for breast/chest wall and internal mammary-medial supraclavicular lymph node chain

442 Poster Comparison between two different irradiation techniques for breast/chest wall and internal mammary-medial supraclavicular lymph node chain

A glance on quality assurance in EORTC study 22922 evaluating techniques for internal mammary and medial supraclavicular lymph node chain irradiation in breast cancer

Purpose: To evaluate the irradiation techniques used for the irradiation of the internal mammary and medial supraclavicular lymph node chain (IM-MS) in the EORTC 22922 study, which evaluates its impact on survival in stage I–III breast cancer patients with axillary node invasion and/or central or medial location of the primary tumour. Materials and methods: The analysis was performed based on the dummy run data of the Quality Assurance Programme of the study. A standard irradiation technique was proposed within the study protocol, and the use of other treatment set-up techniques was allowed. Results: By March 2000, 39 centres from 12 different countries had participated in the study; 32 of these had already fulfilled the dummy run procedure. No centres had to be excluded from the study. Seventy-eight percent of the centres are using the standard irradiation technique, 64% of these with minor variations. Twenty-two percent of the centres developed an alternative irradiation technique. The remarks to the centres using the standard set-up were most often related to the junction problem and the possible under- or overdosage in the target volumes. The remarks to the centres with alternative techniques most often concerned the possible enhanced dose to the lungs and the heart. Conclusion: In a multi-centre trial an easy irradiation technique applicable in a large number of centres should be provided. A quality assurance programme allows early detection of possible problems with treatment planning and delivery. The analysis of the dummy run data showed that if the recommendations of the Quality Assurance Committee are applied, both standard and alternative IM-MS irradiation techniques produce acceptable dose distributions.

Influence of systemic therapy on pulmonary function tests in breast cancer patients irradiated to the internal mammary and medial supraclavicular lymph node chain

Influence of systemic therapy on pulmonary function tests in breast cancer patients irradiated to the internal mammary and medial supraclavicular lymph node chain

Quality assurance in the EORTC phase III randomised trial 22922/10925 investigating the role of internal mammary and medial supraclavicular lymph node chain irradiation in stage I–III breast cancer: A report on the dummy run

Quality assurance in the EORTC phase III randomised trial 22922/10925 investigating the role of internal mammary and medial supraclavicular lymph node chain irradiation in stage I–III breast cancer: A report on the dummy run