Limited Value of Staging Squamous Cell Carcinoma of the Anal Margin and Canal Using the Sentinel Lymph Node Procedure: A Prospective Study with Long-Term Follow-Up
Identifieur interne : 005818 ( Main/Exploration ); précédent : 005817; suivant : 005819Limited Value of Staging Squamous Cell Carcinoma of the Anal Margin and Canal Using the Sentinel Lymph Node Procedure: A Prospective Study with Long-Term Follow-Up
Auteurs : Johannes S. De Jong [Pays-Bas] ; Jannet C. Beukema [Pays-Bas] ; Gooitzen M. Van Dam [Pays-Bas] ; Riemer Slart [Pays-Bas] ; Clara Lemstra [Pays-Bas] ; Theo Wiggers [Pays-Bas]Source :
- Annals of Surgical Oncology [ 1068-9265 ] ; 2010.
Abstract
Selection of patients with anal cancer for groin irradiation is based on tumor size, palpation, ultrasound, and fine needle cytology. Current staging of anal cancer may result in undertreatment in small tumors and overtreatment of large tumors. This study reports the feasibility of the sentinel lymph node biopsy (SLNB) in patients with anal cancer and whether this improves the selection for inguinal radiotherapy.
A total of 50 patients with squamous anal cancer were evaluated prospectively. Patients without a SLNB (
SLNs were found in all 21 patients who underwent a SLNB. There were 5 patients (24%) who had complications after SLNB and 7 patients (33%) who had a positive SLN and received inguinal irradiation. However, 2 patients with a tumor-free SLN and no inguinal irradiation developed lymph node metastases after 12 and 24 months, respectively.
We conclude that SLNB in anal cancer is technically feasible. SLNB can identify those patients who would benefit from refrain of inguinal irradiation treatment and thereby reducing the incidence of unnecessary inguinal radiotherapy. However, because of the occurrence of inguinal lymph node metastases after a tumor-negative SLNB, introduction of this procedure as standard of care in all patients with anal carcinoma should be done with caution to avoid undertreatment of patient who otherwise would benefit from inguinal radiotherapy.
Url:
DOI: 10.1245/s10434-010-1063-7
PubMed: 20865825
PubMed Central: 2941712
Affiliations:
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De Jong</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen</wicri:regionArea><placeName><settlement type="city">Groningue</settlement><region nuts="2" type="province">Groningue (province)</region></placeName></affiliation></author><author><name sortKey="Beukema, Jannet C" sort="Beukema, Jannet C" uniqKey="Beukema J" first="Jannet C." last="Beukema">Jannet C. Beukema</name><affiliation wicri:level="3"><nlm:aff id="Aff2">Department of Radiotherapy, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Radiotherapy, University Medical Center Groningen, University of Groningen, Groningen</wicri:regionArea><placeName><settlement type="city">Groningue</settlement><region nuts="2" type="province">Groningue (province)</region></placeName></affiliation></author><author><name sortKey="Van Dam, Gooitzen M" sort="Van Dam, Gooitzen M" uniqKey="Van Dam G" first="Gooitzen M." last="Van Dam">Gooitzen M. Van Dam</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen</wicri:regionArea><placeName><settlement type="city">Groningue</settlement><region nuts="2" type="province">Groningue (province)</region></placeName></affiliation></author><author><name sortKey="Slart, Riemer" sort="Slart, Riemer" uniqKey="Slart R" first="Riemer" last="Slart">Riemer Slart</name><affiliation wicri:level="3"><nlm:aff id="Aff3">Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen</wicri:regionArea><placeName><settlement type="city">Groningue</settlement><region nuts="2" type="province">Groningue (province)</region></placeName></affiliation></author><author><name sortKey="Lemstra, Clara" sort="Lemstra, Clara" uniqKey="Lemstra C" first="Clara" last="Lemstra">Clara Lemstra</name><affiliation wicri:level="3"><nlm:aff id="Aff3">Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen</wicri:regionArea><placeName><settlement type="city">Groningue</settlement><region nuts="2" type="province">Groningue (province)</region></placeName></affiliation></author><author><name sortKey="Wiggers, Theo" sort="Wiggers, Theo" uniqKey="Wiggers T" first="Theo" last="Wiggers">Theo Wiggers</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen</wicri:regionArea><placeName><settlement type="city">Groningue</settlement><region nuts="2" type="province">Groningue (province)</region></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">20865825</idno><idno type="pmc">2941712</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941712</idno><idno type="RBID">PMC:2941712</idno><idno type="doi">10.1245/s10434-010-1063-7</idno><date when="2010">2010</date><idno type="wicri:Area/Pmc/Corpus">000C12</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000C12</idno><idno type="wicri:Area/Pmc/Curation">000C11</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000C11</idno><idno type="wicri:Area/Pmc/Checkpoint">003360</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">003360</idno><idno type="wicri:Area/Ncbi/Merge">003E31</idno><idno type="wicri:Area/Ncbi/Curation">003E31</idno><idno type="wicri:Area/Ncbi/Checkpoint">003E31</idno><idno type="wicri:doubleKey">1068-9265:2010:De Jong J:limited:value:of</idno><idno type="wicri:Area/Main/Merge">005868</idno><idno type="wicri:Area/Main/Curation">005818</idno><idno type="wicri:Area/Main/Exploration">005818</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Limited Value of Staging Squamous Cell Carcinoma of the Anal Margin and Canal Using the Sentinel Lymph Node Procedure: A Prospective Study with Long-Term Follow-Up</title><author><name sortKey="De Jong, Johannes S" sort="De Jong, Johannes S" uniqKey="De Jong J" first="Johannes S." last="De Jong">Johannes S. De Jong</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen</wicri:regionArea><placeName><settlement type="city">Groningue</settlement><region nuts="2" type="province">Groningue (province)</region></placeName></affiliation></author><author><name sortKey="Beukema, Jannet C" sort="Beukema, Jannet C" uniqKey="Beukema J" first="Jannet C." last="Beukema">Jannet C. Beukema</name><affiliation wicri:level="3"><nlm:aff id="Aff2">Department of Radiotherapy, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Radiotherapy, University Medical Center Groningen, University of Groningen, Groningen</wicri:regionArea><placeName><settlement type="city">Groningue</settlement><region nuts="2" type="province">Groningue (province)</region></placeName></affiliation></author><author><name sortKey="Van Dam, Gooitzen M" sort="Van Dam, Gooitzen M" uniqKey="Van Dam G" first="Gooitzen M." last="Van Dam">Gooitzen M. Van Dam</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen</wicri:regionArea><placeName><settlement type="city">Groningue</settlement><region nuts="2" type="province">Groningue (province)</region></placeName></affiliation></author><author><name sortKey="Slart, Riemer" sort="Slart, Riemer" uniqKey="Slart R" first="Riemer" last="Slart">Riemer Slart</name><affiliation wicri:level="3"><nlm:aff id="Aff3">Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen</wicri:regionArea><placeName><settlement type="city">Groningue</settlement><region nuts="2" type="province">Groningue (province)</region></placeName></affiliation></author><author><name sortKey="Lemstra, Clara" sort="Lemstra, Clara" uniqKey="Lemstra C" first="Clara" last="Lemstra">Clara Lemstra</name><affiliation wicri:level="3"><nlm:aff id="Aff3">Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen</wicri:regionArea><placeName><settlement type="city">Groningue</settlement><region nuts="2" type="province">Groningue (province)</region></placeName></affiliation></author><author><name sortKey="Wiggers, Theo" sort="Wiggers, Theo" uniqKey="Wiggers T" first="Theo" last="Wiggers">Theo Wiggers</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen</wicri:regionArea><placeName><settlement type="city">Groningue</settlement><region nuts="2" type="province">Groningue (province)</region></placeName></affiliation></author></analytic><series><title level="j">Annals of Surgical Oncology</title><idno type="ISSN">1068-9265</idno><idno type="eISSN">1534-4681</idno><imprint><date when="2010">2010</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Selection of patients with anal cancer for groin irradiation is based on tumor size, palpation, ultrasound, and fine needle cytology. Current staging of anal cancer may result in undertreatment in small tumors and overtreatment of large tumors. This study reports the feasibility of the sentinel lymph node biopsy (SLNB) in patients with anal cancer and whether this improves the selection for inguinal radiotherapy.</p></sec><sec><title>Methods</title><p>A total of 50 patients with squamous anal cancer were evaluated prospectively. Patients without a SLNB (<italic>n</italic> = 29) received irradiation of the inguinal lymph nodes based on lymph node status, tumor size, and location of the primary tumor. Inguinal irradiation treatment in patients with a SLNB was based on the presence of metastases in the SLN.</p></sec><sec><title>Results</title><p>SLNs were found in all 21 patients who underwent a SLNB. There were 5 patients (24%) who had complications after SLNB and 7 patients (33%) who had a positive SLN and received inguinal irradiation. However, 2 patients with a tumor-free SLN and no inguinal irradiation developed lymph node metastases after 12 and 24 months, respectively.</p></sec><sec><title>Conclusions</title><p>We conclude that SLNB in anal cancer is technically feasible. SLNB can identify those patients who would benefit from refrain of inguinal irradiation treatment and thereby reducing the incidence of unnecessary inguinal radiotherapy. However, because of the occurrence of inguinal lymph node metastases after a tumor-negative SLNB, introduction of this procedure as standard of care in all patients with anal carcinoma should be done with caution to avoid undertreatment of patient who otherwise would benefit from inguinal radiotherapy.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Gerard, Jp" uniqKey="Gerard J">JP Gerard</name></author><author><name sortKey="Chapet, O" uniqKey="Chapet O">O Chapet</name></author><author><name sortKey="Samiei, F" uniqKey="Samiei F">F Samiei</name></author><author><name sortKey="Morignat, E" uniqKey="Morignat E">E Morignat</name></author><author><name sortKey="Isaac, S" uniqKey="Isaac S">S Isaac</name></author><author><name sortKey="Paulin, C" uniqKey="Paulin C">C Paulin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fuchshuber, Pr" uniqKey="Fuchshuber P">PR 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Nieweg</name></author><author><name sortKey="Gilhuijs, Kg" uniqKey="Gilhuijs K">KG Gilhuijs</name></author><author><name sortKey="Peterse, Jl" uniqKey="Peterse J">JL Peterse</name></author><author><name sortKey="Rutgers, Ej" uniqKey="Rutgers E">EJ Rutgers</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rijk, Mc" uniqKey="Rijk M">MC Rijk</name></author><author><name sortKey="Teerstra, Hj" uniqKey="Teerstra H">HJ Teerstra</name></author><author><name sortKey="Peterse, Jl" uniqKey="Peterse J">JL Peterse</name></author><author><name sortKey="Nieweg, Oe" uniqKey="Nieweg O">OE Nieweg</name></author><author><name sortKey="Olmos, Ra" uniqKey="Olmos R">RA Olmos</name></author><author><name sortKey="Hoefnagel, Ca" uniqKey="Hoefnagel C">CA Hoefnagel</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Crawshaw, Jw" uniqKey="Crawshaw J">JW Crawshaw</name></author><author><name sortKey="Hadway, P" uniqKey="Hadway P">P Hadway</name></author><author><name sortKey="Hoffland, D" uniqKey="Hoffland D">D Hoffland</name></author><author><name sortKey="Bassingham, S" uniqKey="Bassingham S">S Bassingham</name></author><author><name sortKey="Corbishley, Cm" uniqKey="Corbishley C">CM Corbishley</name></author><author><name sortKey="Smith, Y" uniqKey="Smith Y">Y Smith</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nguyen, Bt" uniqKey="Nguyen B">BT Nguyen</name></author><author><name sortKey="Joon, Dl" uniqKey="Joon D">DL Joon</name></author><author><name sortKey="Khoo, V" uniqKey="Khoo V">V Khoo</name></author><author><name sortKey="Quong, G" uniqKey="Quong G">G Quong</name></author><author><name sortKey="Chao, M" uniqKey="Chao M">M Chao</name></author><author><name sortKey="Wada, M" uniqKey="Wada M">M Wada</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Pays-Bas</li></country><region><li>Groningue (province)</li></region><settlement><li>Groningue</li></settlement></list><tree><country name="Pays-Bas"><region name="Groningue (province)"><name sortKey="De Jong, Johannes S" sort="De Jong, Johannes S" uniqKey="De Jong J" first="Johannes S." last="De Jong">Johannes S. De Jong</name></region><name sortKey="Beukema, Jannet C" sort="Beukema, Jannet C" uniqKey="Beukema J" first="Jannet C." last="Beukema">Jannet C. Beukema</name><name sortKey="Lemstra, Clara" sort="Lemstra, Clara" uniqKey="Lemstra C" first="Clara" last="Lemstra">Clara Lemstra</name><name sortKey="Slart, Riemer" sort="Slart, Riemer" uniqKey="Slart R" first="Riemer" last="Slart">Riemer Slart</name><name sortKey="Van Dam, Gooitzen M" sort="Van Dam, Gooitzen M" uniqKey="Van Dam G" first="Gooitzen M." last="Van Dam">Gooitzen M. Van Dam</name><name sortKey="Wiggers, Theo" sort="Wiggers, Theo" uniqKey="Wiggers T" first="Theo" last="Wiggers">Theo Wiggers</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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