Single photon emission computed tomography-computed tomography visualization of sentinel lymph nodes for lymph flow guided nodal irradiation in oral tongue cancer

다국어 초록 (Multilingual Abstract)

Purpose: To evaluate correlation of single photon emission computed tomography-computed tomography (SPECT-CT) data on lymph flow (LF) from oral tongue cancer (OC) and the topography of lymph nodes (LN) metastases; to determine the clinical value of lymph flow guided radiotherapy (LFGRT). Materials and Methods: SPECT-CT visualization of LF from the OC lesions was performed after peritumoral injection of 99mTc-phytate in 26 primary patients with clinical stage cT1-2N0M0 disease. We determined the individual drainage (unilateral/bilateral) from the tumor, and localization of sentinel LNs according to the neck levels. Metastases in LNs were verified with histology and a 2-year follow-up. Results: SPECT-CT detected bilateral LF in 10 (38.5%) of 26 patients; in 16 (61.5%) cases the drainage was unilateral. Histology revealed LNs metastases in three cases; regional recurrences were diagnosed in other four patients. In all seven observations metastases were located at the same site and level as the sentinel LNs. In eight (30.8%) of 26 patients sentinel LNs were visualized unilaterally at levels Ib-IIa; in five cases, unilaterally at levels I-IIa-III. In these patients, LFGRT demonstrated 59%-70% reduction of irradiated volume, and 26%-42% and 51%-70% decrease of the mean dose to the spinal cord and the contralateral parotid gland. In patients with a bilateral drainage the reduction of doses absorbed by the spinal cord and contralateral parotid gland was 19% and 6%, respectively. Conclusion: Localization of sentinel LNs determined by SPECT-CT corresponds to the localization of metastatic LNs in terms of side and levels.

목차 (Table of Contents)

• Introduction Materials and Methods Results Discussion and Conclusion Conflict of Interest References

참고문헌 (Reference)

1 Zhang H, "Utility of PET-CT in detecting nodal metastasis in cN0 early stage oral cavity squamous cell carcinoma" 80 : 89-92, 2018

2 Jellema AP, "Unilateral versus bilateral irradiation in squamous cell head and neck cancer in relation to patient-rated xerostomia and sticky saliva" 85 : 83-89, 2007

3 Tartaglione G, "Sentinel node in oral cancer : the nuclear medicine aspects : a survey from the Sentinel European Node Trial" 41 : 534-542, 2016

4 Miura K, "Sentinel node biopsy for oral cancer : a prospective multicenter phase II trial" 44 : 319-326, 2017

5 Sagheb K, "Sentinel lymph node biopsy in T1/T2 squamous cell carcinomas of the tongue : a prospective study" 11 : 600-604, 2016

6 Schilling C, "Sentinel European Node Trial(SENT) : 3-year results of sentinel node biopsy in oral cancer" 51 : 2777-2784, 2015

7 de Veij Mestdagh PD, "SPECT/CT-guided lymph drainage mapping for the planning of unilateral elective nodal irradiation in head and neck squamous cell carcinoma" 275 : 2135-2144, 2018

8 de Veij Mestdagh PD, "SPECT/CT-guided elective nodal irradiation for head and neck cancer is oncologically safe and less toxic : a potentially practice-changing approach" 147 : 56-63, 2020

9 Daisne JF, "SPECT/CT lymphoscintigraphy of sentinel node(s)for superselective prophylactic irradiation of the neck in cN0 head and neck cancer patients : a prospective phase I feasibility study" 9 : 121-, 2014

10 Garrel R, "Review of sentinel node procedure in cN0 head and neck squamous cell carcinomas : guidelines from the French evaluation cooperative subgroup of GETTEC" 134 : 89-93, 2017

11 Krengli M, "Potential advantage of studying the lymphatic drainage by sentinel node technique and SPECT-CT image fusion for pelvic irradiation of prostate cancer" 66 : 1100-1104, 2006

12 Kerawala C, "Oral cavity and lip cancer : United Kingdom National Multidisciplinary Guidelines" 130 (130): S83-S89, 2016

13 Farmer RW, "Lymphatic drainage patterns in oral squamous cell carcinoma : findings of the ACOSOG Z0360(Alliance)study" 152 : 673-677, 2015

14 Novikov SN, "Lymph flow guided irradiation of regional lymph nodes in patients with cervical cancer : preliminary analysis of scintigraphic data" 23 : 503-509, 2018

15 Singh B, "Ipsilateral neck nodal status as predictor of contralateral nodal metastasis in carcinoma of tongue crossing the midline" 35 : 649-652, 2013

16 D’Cruz AK, "Elective versus therapeutic neck dissection in node-negative oral cancer" 373 : 521-529, 2015

17 Al-Mamgani A, "Elective unilateral nodal irradiation in head and neck squamous cell carcinoma : a paradigm shift" 82 : 1-5, 2017

18 de Bondt RB, "Detection of lymph node metastases in head and neck cancer: a meta-analysis comparing US, USgFNAC, CT and MR imaging" 64 : 266-272, 2007

19 Gregoire V, "Delineation of the neck node levels for head and neck tumors: a 2013 update: DAHANCA, EORTC, HKNPCSG, NCIC CTG, NCRI, RTOG, TROG consensus guidelines" 110 : 172-181, 2014

20 Genden EM, "Contemporary management of cancer of the oral cavity" 267 : 1001-1017, 2010

21 Novikov SN, "Comparison of two treatment strategies for irradiation of regional lymph nodes in patients with breast cancer : lymph flow guided portals versus standard radiation fields" 20 : 27-31, 2014

22 Goel R, "Clinical practice in PET/CT for the management of head and neck squamous cell cancer" 209 : 289-303, 2017

23 Neiweg OE, "Atlas of lymphoscintigraphy and sentinal node mapping: a pictorial case-based approach" Springer 143-149, 2020

24 Chen MM, "Association of postoperative radiotherapy with survival in patients with N1 oral cavity and oropharyngeal squamous cell carcinoma" 142 : 1224-1230, 2016