Metastatic carcinoma in cervical lymph nodes

The objective of this study is the correlation between the different groups of cervical lymph nodes and the primary tumours above the clavicles. Cervical lymph node metastases as the only site of disease is an uncommon presentation of squamous cell carcinoma and adenocarcinoma of unknown primary origin. This retrospective analysis examines the records of 166 consecutive patients at King Hussein Medical Centre diagnosed between 1986 - 1992. All patients presented very late with large neck lymph nodes of more than 4-8 cm in diameter. The diagnostic protocol employed and the results of radical treatment are evaluated. Sixty seven patients received radiation therapy with intent to cure and 99 patients received radiation with intent to palliate. The overall survival for all patients at 2 years was 19%, and at 5 years, 6 patients [3.6%]. The most frequently affected nodes were the jugulodigastric, mid jugular, submandibular and cervical unilateral, contralateral or bilateral. The most common histologies were squamous cell carcinoma, adneocarcinoma and anaplastic carcinoma. Disease control above the clavicles was not achieved despite radical treatment. Lymphomas and leukaemias were excluded from this study

Modified clearing technique to identify lymph node metastases in post-irradiated surgical specimens from rectal adenocarcinoma

The aim of this study is to describe a modification of the original method of clearing lymph nodes in specimens from rectal adenocarcinoma and its yield in comparison to a control group whose specimens were studied by a manual technique. There were 32 consecutive patients with locally advanced rectal adenocarcinoma. All patients received preoperative radiation therapy (PRT) at doses of 45 Gy, concomitant with 5-fluourouracil at the doses of 450 mg/m² IV bolus, days 1-5 and 28-33 of PRT; 4-8 weeks later radical surgery with a curative intent was performed. Twenty two specimens were studied by a manual technique consisting of fixation in 10 per cent formalin. Ten specimens wer studied with the modified clearing technique consisting of administration through the inferior mesenteric artery of methylene blue; fixation with 10 per cent formalin plus 0.01 per cent of methylene blue; clearing the fat with a sequence of 95 per cent alcohol - 100 per cent acetone - 100 per cent xylene. In the 32 specimens, 413 lymph nodes were found. Using the manual technique 104 lymph nodes were found (average 4.7 lymph nodes per specimen); 309 lymph nodes by the modified clearing technique (average 30.9 lymph nodes per specimen), (p<0.0001). Using the manual technique 23 out of 104 lymph nodes (22 per cent) contained metastases. All metastatic lymph nodes measered > 5 mm; 18 out of 23 metastatic lymph nodes were located on the perirectal area (level 2); and five were located in the root of the inferior mesenteric artery (level 5). Using the modified clearing technique is a quick, easy and reproducible method for identifying lymph nodes in post-irradiated surgical specimens. In comparison to the traditional manual method of searching for lymph nodes, it improves in the detection of small lymph nodes (>5 mm), allowing better staging in patients with rectal adenocarcinoma

Role of extended para-aortic lymph nodes irradiation in the management of carcinoma of uterine cervix

This study included the analysis of 70 patients admitted to Radiotherapy and Oncology Unit, Faculty of Medicine, University of Alexandria with histologically proved carcinoma of the cervix and with positive pelvic with or without para-aortic lymph nodes as demonstrated by lymphography alone. Cases were treated radically by radiotherapy. External irradiation was delivered by extended field technique in groups 1 and 2, while in group 3 it was delivered to pelvic region only [group 1 para-aortic lymph nodes were treated therapeutically, while in group 2 it was prophylactically treated]. Treatment tolerance was approximately the same for all field sizes except when the field was extended to include the para-aortic region. Poor tolerance with severe nausea, vomiting and diarrhea requiring frequent interruption of irradiation was observed in 33.3% and 25% of cases of extended field group [group 1 and group 2, respectively] compared with 5.7% of cases in the pelvic group only [group 3], P <0.05. Such poor tolerance was more experienced in patients above the age of 50 years. The incidence of late complication was more pronounced in group 1 and group 2 compared with that of group 3 [48.5% versus 34%, respectively], P >0.05. Nominal st and ard dose [NSD] and biological effective dose [BED] were calculated for extended field groups 1 and 2. Para-aortic treatment failures were 14.2% in groups 1 and 2 versus 17.2% in group 3 [P >0.05]. Locoregional treatment was not found to influence the incidence of distant metastasis, the latter were nearly the same in all treatment groups. Furthermore, there was no significant difference in the overall and disease free survival results among the different therapeutic groups included