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KMID : 1038620210390030193
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Radiation Oncology Journal
2021 Volume.39 No. 3 p.193 ~ p.201
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Single photon emission computed tomography-computed tomography visualization of sentinel lymph nodes for lymph flow guided nodal irradiation in oral tongue cancer
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Novikov Sergey Nikolaevich
Krzhivitskii Pavel Ivanovich
Radgabova Zamira Achmedovna
Kotov Maxim Andreevitch
Girshovich Mikhail Markovich
Artemyeva Anna Sergeevna
Melnik Yulia Sergeevna
Kanaev Sergey Vasilevich
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Abstract
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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.
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KEYWORD
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Oral tongue cancer, Sentinel lymph nodes, Lymph flow, Radiotherapy
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