Extracapsular axillary node extension in patients receiving adjuvant systemic therapy: An indication for radiotherapy?

Fisher, Barbara; Perera, Francisco; Cooke, Andrew; Opeitum, A.; Dar, A. Rashid; Venkatesan, Varagur; Stitt, Larry; Radwan, John S.

doi:10.1016/s0360-3016(97)89483-7

Cited by 81 publications

(45 citation statements)

References 13 publications

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“…It has been shown that axillary irradiation is not needed after complete axillary dissection and that the postoperative treatment only increases the arm complication rate (42,43). Thus, lymph node irradiation is currently limited to the apex of the axilla, supraclavicular and IMC, except for cases in which a massive involvement of the axillary fat tissue is found (44,45). Irradiation of the breast or chest wall is generally performed, as this is the major site of failure.…”

Section: ) Total Dosementioning

confidence: 99%

Adjuvant Radiotherapy in Breast Cancer: The Treatment of Lymph Node Areas

Arriagada

Lê

2000

Acta Oncologica

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Section: ) Total Dosementioning

confidence: 99%

Adjuvant Radiotherapy in Breast Cancer: The Treatment of Lymph Node Areas

Arriagada

Lê

2000

Acta Oncologica

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“…Identification of those who are at greatest risk for developing distant metastasis and mortality from prostate cancer will help stratify patients into prognostically distinct groups. Previous studies demonstrated that assessment of extranodal extension (ENE) in patients who are node positive may provide prognostic information in certain human epithelial malignancies, including breast cancer (10,11), squamous cell carcinoma of the vulva (12,13), gastric carcinoma (14), and squamous carcinoma of the head and neck (15)(16)(17)(18)(19)(20)(21). Others refuted the significance of ENE (22)(23)(24)(25)(26).…”

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confidence: 99%

Extranodal Extension in Lymph Node–Positive Prostate Cancer

et al. 2000

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Evaluation of extranodal tumor extension may provide prognostic information for patients with epithelial malignancies. However, its importance for the patient who has prostate cancer with regional lymph node metastasis requires further investigation and clarification. This study was performed to evaluate the prognostic significance of extranodal extension (ENE) in a large series of node-positive patients. The study group included 212 nodepositive patients who were treated by bilateral pelvic lymphadenectomy, radical retropubic prostatectomy, and androgen deprivation between 1987 and 1992 at the Mayo Clinic. ENE was defined as cancer perforating through the lymph node capsule into perinodal tissue. Nodal cancer volume was measured by the grid method. Univariate and multivariate risk ratios (RR) for distant metastasis-free and cancer-specific survival were estimated using the Cox proportional model. The mean follow-up was 6.3 years (median, 6.1 years). Distant metastasisfree and cancer-specific survival at 5 years for all patients was 91% and 95%, respectively. ENE was found in 126 of 212 patients (59%). The presence of ENE was not significantly associated with distant metastasis-free (RR ‫؍‬ 1.6; 95% confidence interval [CI], 0.7 to 3.9) or cancer-specific survival (RR ‫؍‬ 2.2; 95% CI, 0.7 to 6.8). Among 98 patients with a single positive node, there was no significant difference in distant metastasis or cancer-specific survival according to the presence of ENE (P ‫؍‬ .88 and P ‫؍‬ .36, respectively). After adjusting for Gleason score, DNA ploidy, and ENE, only nodal cancer volume was significantly associated with adverse distant metastasis-free (RR ‫؍‬ 1.9; 95% CI, 1.5 to 2.8) and cancer-specific survival (RR ‫؍‬ 1.4; 95% CI, 1.1 to 1.9). Our data indicate that the presence of ENE is not associated with unfavorable survival in patients with node-positive prostate cancer treated by radical retropubic prostatectomy, bilateral pelvic lymphadenectomy, and androgen deprivation therapy. In contrast, nodal cancer volume was predictive of distant metastasis-free survival and cancerspecific survival.

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“…For several nongastrointestinal malignancies, like breast, prostate, pharynx, larynx, and bladder cancer, the prognostic value of extracapsular lymph node involvement has already been investigated. [14][15][16][17][18][19][20] In most of these studies, patients with extracapsular lymph node involvement had a poorer overall and disease-free survival compared with patients without extracapsular lymph node involvement. But up to this time, only a few studies have reported on extracapsular lymph node involvement in relation to gastric cancer.…”

Section: Discussionmentioning

confidence: 99%

Extracapsular lymph node spread

Alakus

Hölscher

Grass

et al. 2009

Cancer

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BACKGROUND: Lymphatic spread is 1 of the most relevant prognostic factors for gastric carcinoma. The current International Union Against Cancer (UICC) pN staging system is based on the number of metastatic lymph nodes and does not take into consideration the characteristics of the metastatic lymph nodes itself. The aim of the current study was to examine the prognostic value of extracapsular lymph node involvement in gastric cancer and to find correlations with clinicopathological parameters. METHODS: Tissue samples were obtained from 159 gastric cancer patients who underwent gastrectomy with D2-lymphadenectomy in 142 (89.3%) cases and subtotal gastrectomy with D2-lymphadenectomy in 17 (10.7%) cases. The number of resected lymph nodes, number of metastatic lymph nodes, and number of metastatic lymph nodes with extracapsular lymph node involvement were determined. Extracapsular spread was defined as infiltration of cancer cells beyond the capsule of the metastatic lymph node. RESULTS: Ninetysix (60.4%) patients had lymph node metastasis. In 57 (35.8%) cases, extracapsular lymph node involvement was also detected. Extracapsular lymph node involvement was significantly associated with higher pN-category (P < .001), higher pM category (P ¼ .048), and higher UICC stages (P ¼ .001). According to the Kaplan-Meier log-rank statistical method, extracapsular lymph node involvement was significantly associated with poor survival (P ¼ .001). In the multivariate analysis besides pT (P < .001) and R-category (P ¼ .009), extracapsular lymph node involvement also remained as an independent prognostic factor (P ¼ .003), whereas the UICC pN-category (P ¼ .822) lost its prognostic value. CONCLUSIONS: Extracapsular lymph node involvement is associated with higher tumor stages and is an independent negative prognostic factor in gastric cancer. In future staging systems for gastric cancer, extracapsular lymph node involvement should be considered. Cancer 2010;116:309-15.

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Extracapsular axillary node extension in patients receiving adjuvant systemic therapy: An indication for radiotherapy?

Cited by 81 publications

References 13 publications

Adjuvant Radiotherapy in Breast Cancer: The Treatment of Lymph Node Areas

Adjuvant Radiotherapy in Breast Cancer: The Treatment of Lymph Node Areas

Extranodal Extension in Lymph Node–Positive Prostate Cancer

Extracapsular lymph node spread

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