Analysis of paraaortic lymph node involvement in pancreatic carcinoma

Kayahara, Masato; Nagakawa, Takukazu; Ohta, Tetsuo; Kitagawa, Hirohisa; Ueno, Koichi; Tajima, Hidehiro; Elnemr, Ayman; Miwa, Koichi

doi:10.1002/(sici)1097-0142(19990201)85:3<583::aid-cncr8>3.0.co;2-j

Cited by 91 publications

(74 citation statements)

References 19 publications

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“…This limitation should be kept in mind, as the sensitivity of currently available imaging methods to predict nodal involvement is poor [17,26]. Other groups have considered elective nodal irradiation to be appropriate due to a high likelihood of lymph node involvement in approximately 75-80% of patients who underwent surgical resection for pancreatic tumors [5,18]. Nevertheless, our approach results in the PTV encompassing the most common locations for nodal metastases, which are the peripancreatic and pancreaticoduodenal areas.…”

Section: F-imrtmentioning

confidence: 99%

Volumetric Modulated Arc Therapy for Advanced Pancreatic Cancer

et al. 2010

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Background: Intensity-modulated radiotherapy (IMRT) allows for improved sparing of organs at risk (OARs) in advanced pancreatic cancer. A planning study evaluated if volumetric modulated arc therapy (RapidArc™ [RA]) could be used as an alternative to IMRT in such cases. Patients and Methods: In ten patients, five-field IMRT (5f-IMRT) plans with fixed gantry positions were compared to RA plans using similar constraints for planning target volume (PTV) and OARs. PTV coverage, conformity indices (CI), and OAR doses were compared. One patient was treated using RA and calculated dose distributions were measured in coronal planes in a solid-water phantom. Results: RA plans showed superior mean CI of 1.09 ± 0.02 (± 1 SD [standard deviation]) versus 1.20 ± 0.10 in 5f-IMRT (p = 0.003). Both techniques achieved similar sparing of the right kidney, but RA significantly reduced left kidney doses with V 15 of 7.2% ± 5.3% and 15.9% ± 11.1%, respectively; p = 0.02. RA modestly decreased mean doses to liver (13.8 vs. 15.1 Gy; p = 0.003), stomach (16.7 vs. 17.9 Gy; p = 0.017), small bowel (19.8 vs. 22.1 Gy; p < 0.001), and duodenum (38.8 vs. 41.9 Gy; p = 0.004). Film dosimetry revealed excellent agreement between calculated and measured dose distributions. The delivery time for RA was < 3 min. Conclusion: RA planning achieved superior CI for pancreatic tumors compared to 5f-IMRT, and modestly reduced OAR doses. Fast treatment delivery using RA may decrease the risk of intrafractional organ motion. Ergebnisse: RA-Pläne zeigten einen günstigeren CI von 1,09 ± 0,02 (± 1 SD [Standardabweichung]) gegenüber 1,20 ± 0,10 bei 5f-IMRT (p = 0,003). Mit beiden Techniken gelang eine zufriedenstellende Dosisreduktion der rechten Niere, mittels RA konnten jedoch die V 15 der linken Niere signifikant reduziert werden (7,2% ± 5,3% vs. 15,9% ± 11,1% bei IMRT; p = 0,02). Geringer zeigte sich die Reduktion der mittleren Dosis der Leber (13,8 vs. 15,1 Gy; p = 0,003), des Magens (16,7 vs. 17,9 Gy; p = 0,017), des Dünndarms (19,8 vs. 22,1 Gy; p < 0,001) und des Duodenums (38,8 vs. 41,9 Gy; p = 0,004). Filmdosimetrische Überprüfungen zeigten hervorragende Übereinstimmungen bezüglich kalkulierter und tatsächlicher Dosisverteilung. Die Gesamtbestrahlungszeit betrug < 3 min. Schlussfolgerung: Mittels RA-Planung lässt sich im Vergleich zur 5f-IMRT sowohl ein günstigerer CI als auch moderate Dosisreduktion in den OAR erreichen. Durch die rasche Dosisapplikation vermindert sich das Risiko intrafraktionärer Bewegung der OAR.Schlüsselwörter: Pankreaskarzinom · "Volumetric modulated arc therapy" · Intensitätsmodulierte Radiotherapie · Planungsstudie · Risikoorgane

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Section: F-imrtmentioning

confidence: 99%

Volumetric Modulated Arc Therapy for Advanced Pancreatic Cancer

et al. 2010

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“…Over the past several years, radical resection has evolved to be most commonly defined as a wide en bloc pancreaticoduodenal resection, incorporating a wide soft tissue resection margin including extrapancreatic nerve plexuses, combined with the harvest of specific lymph node stations and a retroperitoneal lymphadenectomy (1)(2)(3)(4). The rationale for more extensive surgery was based on the observation that a standard operation fails to remove nodal groups that even in patients with small neoplasms often are involved with microscopic disease.…”

Section: Introductionmentioning

confidence: 99%

“…The rationale for more extensive surgery was based on the observation that a standard operation fails to remove nodal groups that even in patients with small neoplasms often are involved with microscopic disease. However, dismal complications affecting the quality of life, particularly disturbances in digestive absorption such as diarrhea, are a significant morbidity associated with this type of surgery (3,5). Furthermore, many of those patients who die after a potentially curative resection die from local recurrences (6).…”

Section: Introductionmentioning

confidence: 99%

Carcinomas of the ventral and dorsal pancreas exhibit different patterns of lymphatic spread

Kitagawa

Ohta²,

Makino³

et al. 2008

Front Biosci

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“…On the other hand, extended lymphadenectomy failed the target of prolonging long term survival after PD for pancreatic head cancer [17][18][19][20] . There are increasing reports of long-term survival after resection of pancreatic cancer with PALNS+ [6,7,21,22] , and, based on other prognostic parameters, more selective surgical indication has been suggested. Nappo et al [23] prospectively evaluated 135 patients undergoing PD and PALNs dissection, and found that survival of patients with PALNs+ seems to be comparable to that of patients with other lymph nodes involvement: the presence of PALNs+ should be not considered an absolute contraindication to radical surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the total number of removed nodes and lymph node ratio were recently reported as important indicators of prognosis after surgery [5] . Para-aortic nodes involvement (PALNs) is generally considered as metastatic disease, and resection is not recommended [6,7] . However, some Author reported survival benefit after surgery even when para-aortic nodes were involved by the tumors; so, the real impact of PALNs involvement in pancreatic cancer patients is still controversial [8] .…”

Section: Introductionmentioning

confidence: 99%

Para-aortic node involvement is not an independent predictor of survival after resection for pancreatic cancer

et al. 2017

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AIMTo analyze the importance of para-aortic node status in a series of patients who underwent pancreaticoduodenectomy (PD) in a single Institution. METHODSBetween January 2000 and December 2012, 151 patients underwent PD with para-aortic node dissection for pancreatic adenocarcinoma in our Institution. Patients were divided into two groups: patients with negative PALNs (PALNs-), and patients with metastatic PALNs (PALNs+). Pathologic factors, including stage, nodal status, number of positive nodes and lymph node ratio, invasion of para-aortic nodes, tumor's grading, and radicality of resection were studied by univariate and multivariate analysis. Survival curves were constructed with Kaplan-Meier method and compared with Log-rank test: significance was considered as P < 0.05. RESULTSA total of 107 patients (74%) had nodal metastases. Median number of pathologically assessed lymph nodes was 26 (range 14-63). Twenty-five patients (16.5%) Retrospective Cohort Study had para-aortic lymph node involvement. Thirty-three patients (23%) underwent R1 pancreatic resection. Onehundred forty-one patients recurred and died for tumor recurrence, one is alive with recurrence, and 9 are alive and free of disease. Overall survival was significantly influenced by grading (P = 0.0001), radicality of resection (P = 0.001), stage (P = 0.03), lymph node status (P = 0.04), para-aortic nodes metastases (P = 0.02). Multivariate analysis showed that grading was an independent prognostic factor for overall survival (P = 0.0001), while grading (P = 0.0001) and radicality of resection (P = 0.01) were prognostic parameters for disease-free survival. Number of metastatic nodes, node ratio, and para-aortic nodes involvement were not independent predictors of disease-free and overall survival. ORIGINAL ARTICLE CONCLUSIONIn this experience, lymph node status and para-aortic node metastases were associated with poor survival at univariate analysis, but they were not independent prognostic factors. Core tip: Para-aortic node involvement by pancreatic cancer is traditionally considered as an advanced disease with poor prognosis. We retrospectively examined our experience of 151 patients with pancreatic cancer who underwent resection and para-aortic lymph nodes sampling. Disease-free and overall survival were worse in patients with para-aortic nodes metastases, but multivariate analysis showed that para-aortic node involvement is not an independent prognostic factor after resection of pancreatic cancer. So, the decision to make pancreatic resection should not be based on the paraaortic node status only.Sperti C, Gruppo M, Blandamura S, Valmasoni M, Pozza G, Passuello N, Beltrame V, Moletta L. Para-aortic node involvement is not an independent predictor of survival after resection for pancreatic cancer.

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Analysis of paraaortic lymph node involvement in pancreatic carcinoma

Cited by 91 publications

References 19 publications

Volumetric Modulated Arc Therapy for Advanced Pancreatic Cancer

Volumetric Modulated Arc Therapy for Advanced Pancreatic Cancer

Carcinomas of the ventral and dorsal pancreas exhibit different patterns of lymphatic spread

Para-aortic node involvement is not an independent predictor of survival after resection for pancreatic cancer

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