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Radiation oncology considerations
Published in Charles F. Levenback, Ate G.J. van der Zee, Robert L. Coleman, Clinical Lymphatic Mapping in Gynecologic Cancers, 2022
Gwendolyn Joyce McGinnis, Anuja Jhingran
Paraaortic nodes are often treated in cases of uterine fundus, fallopian tube, or ovarian involvement. They are also included if there are any grossly involved paraaortic lymph nodes. The term ‘extended fields’ is used when paraaortic lymph nodes are included. Radiation fields are extended approximately to the level of T12, or 1.5–2 cm above the level of the most superior grossly involved lymph node. Lower paraaortic nodes are covered prophylactically when there is positive common iliac nodes up to the level of L2.
External Beam Radiotherapy and Brachytherapy
Published in Karl H. Pang, Nadir I. Osman, James W.F. Catto, Christopher R. Chapple, Basic Urological Sciences, 2021
Sophia C. Kamran, Jason A. Efstathiou
Stage I seminoma: adjuvant radiotherapy following radical orchidectomy.Field:Paraaortic lymph nodes alone extending from T11/12 to L5/S120 Gy in 10 fractions (MRC trial showed non-inferiority compared with 30 Gy in 15 fractions).Reduces relapse rate to 1–3% (from ~15–20% with orchidectomy alone).
Gynaecological cancer
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
A CT scan of the abdomen and pelvis will help assess local extension and enlargement of pelvic and para-aortic lymph nodes as well as hydronephrosis. CT is also used to assess liver and lungs to exclude metastases.
Is complete mesocolic excision or total mesorectal excision necessary during cytoreductive surgery in ovarian peritoneal carcinomatosis with colonic involvement?
Published in Acta Chirurgica Belgica, 2023
Kursat Karadayi, Ufuk Karabacak
Colon lymph nodes are divided into four groups [34]. Epicolic lymph nodes are associated with the serosal surface of the colon; paracolic lymph nodes run along the medial of the colon; and intermediate lymph nodes continue along with the ileocolic, right colic, middle colic, left colic, sigmoid, and superior rectal arteries. Later, the lymphatic flow drains into the para-aortic area through the principal lymph nodes, following the inferior and superior mesenteric arteries. Three ways have been detected for the lymphatic spread of ovarian cancer [35]. The first and most common route is para-aortic spread through the lymphatics and then by way of the ovarian vascular structures. The second path uses the para-aortic lymph nodes and then the internal and external iliac lymph nodes through the broad ligaments toward the lateral and posterior pelvic wall. The third, and rarest, is along the round ligament to the external iliac and inguinal region.
Is there any benefit of paraaortic field irradiation in pelvic lymph node positive endometrial cancer patients? A propensity match analysis
Published in Journal of Obstetrics and Gynaecology, 2020
Cem Onal, Sezin Yuce Sari, Berna Akkus Yildirim, Melis Gultekin, Ozan Cem Guler, Ferah Yildiz
Unfortunately, the optimal target volume for RT in patients with stage IIIC EC remains controversial (Rose et al. 1992). The involved nodal fields or extended nodal fields may be used to treat the pelvis with or without paraaortic nodal inclusion. Among the stage IIIC1 patients, the question of whether there may be improved outcomes with the use of extended field RT to prophylactically treat the paraaortic lymph nodes is particularly unclear. Adjuvant combined ChT and RT has been demonstrated to be more effective than RT or ChT alone, and pelvic field RT together with systemic ChT may be efficient, without causing any increase in the toxicity in patients with pelvic lymph node metastases. Thus, we aimed to evaluate the survival outcomes and recurrence patterns in patients with stage IIIC1 EC who received RT to the pelvis (P-RT) or to the pelvis plus paraaortic lymph nodes (PA-RT) with or without systemic ChT.
Fever of unknown origin with rashes in early infancy is indicative of adenosine deaminase type 2 deficiency
Published in Scandinavian Journal of Rheumatology, 2018
H Nihira, K Nakagawa, K Izawa, T Kawai, T Yasumi, R Nishikomori, M Nambu, A Miyagawa-Hayashino, T Nomura, K Kabashima, M Ito, S Iwaki-Egawa, Y Sasahara, M Nakayama, T Heike
A 3-month-old girl, the first child of non-consanguineous healthy Japanese parents, began to suffer target-like erythematous lesions (Figure 1). At 4 months of age, she was admitted to hospital with fever, rashes, and increased serum C-reactive protein levels. There was no evidence of infection, and the fever was refractory to antibiotics. Contrast-enhanced computed tomography and positron emission tomography revealed non-specific enlargement of axillary, inguinal, and para-aortic lymph nodes. Magnetic resonance imaging revealed neither intracranial infarction nor lesions indicative of vascular inflammation. Echocardiography was normal. Bone marrow examination showed normal tri-lineage haematopoiesis. Serum gamma-globulin levels were normal, and no autoantibodies were detected. There were no ocular lesions. Skin biopsy of the erythema revealed interface dermatitis with predominant infiltration by neutrophils but no evidence of vasculitis (Figure 1). High-dose systemic corticosteroids were initiated at 3 weeks post-admission, but only partial and transient improvement of the symptoms and acute-phase reactant levels was noted. Clinical relapse occurred as corticosteroids were tapered. Conventional treatment with an anti-interleukin-6 (anti-IL-6) receptor antibody (tocilizumab) began, which controlled the inflammation along with high-dose steroids.