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Title: Anatomic Distribution of Fluorodeoxyglucose-Avid Para-aortic Lymph Nodes in Patients With Cervical Cancer

Abstract

Purpose: Conformal treatment of para-aortic lymph nodes (PAN) in cervical cancer allows dose escalation and reduces normal tissue toxicity. Currently, data documenting the precise location of involved PAN are lacking. We define the spatial distribution of this high-risk nodal volume by analyzing fluorodeoxyglucose (FDG)-avid lymph nodes (LNs) on positron emission tomography/computed tomography (PET/CT) scans in patients with cervical cancer. Methods and Materials: We identified 72 PANs on pretreatment PET/CT of 30 patients with newly diagnosed stage IB-IVA cervical cancer treated with definitive chemoradiation. LNs were classified as left-lateral para-aortic (LPA), aortocaval (AC), or right paracaval (RPC). Distances from the LN center to the closest vessel and adjacent vertebral body were calculated. Using deformable image registration, nodes were mapped to a template computed tomogram to provide a visual impression of nodal frequencies and anatomic distribution. Results: We identified 72 PET-positive para-aortic lymph nodes (37 LPA, 32 AC, 3 RPC). All RPC lymph nodes were in the inferior third of the para-aortic region. The mean distance from aorta for all lymph nodes was 8.3 mm (range, 3-17 mm), and from the inferior vena cava was 5.6 mm (range, 2-10 mm). Of the 72 lymph nodes, 60% were in the inferior third, 36%more » were in the middle third, and 4% were in the upper third of the para-aortic region. In all, 29 of 30 patients also had FDG-avid pelvic lymph nodes. Conclusions: A total of 96% of PET positive nodes were adjacent to the aorta; PET positive nodes to the right of the IVC were rare and were all located distally, within 3 cm of the aortic bifurcation. Our findings suggest that circumferential margins around the vessels do not accurately define the nodal region at risk. Instead, the anatomical extent of the nodal basin should be contoured on each axial image to provide optimal coverage of the para-aortic nodal compartment.« less

Authors:
; ; ; ;  [1];  [2];  [3]; ;  [4];  [1]
  1. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
  2. Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
  3. Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
  4. Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
Publication Date:
OSTI Identifier:
22420312
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 85; Journal Issue: 4; Other Information: Copyright (c) 2013 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; AORTA; CARCINOMAS; DIAGNOSIS; FLUORODEOXYGLUCOSE; LYMPH NODES; PATIENTS; POSITRON COMPUTED TOMOGRAPHY; RADIATION DOSES; SPATIAL DISTRIBUTION; TOXICITY; UROGENITAL SYSTEM DISEASES; VEINS

Citation Formats

Takiar, Vinita, Fontanilla, Hiral P., Eifel, Patricia J., Jhingran, Anuja, Kelly, Patrick, Iyer, Revathy B., Levenback, Charles F., Zhang, Yongbin, Dong, Lei, and Klopp, Ann, E-mail: aklopp@mdanderson.org. Anatomic Distribution of Fluorodeoxyglucose-Avid Para-aortic Lymph Nodes in Patients With Cervical Cancer. United States: N. p., 2013. Web. doi:10.1016/J.IJROBP.2012.11.032.
Takiar, Vinita, Fontanilla, Hiral P., Eifel, Patricia J., Jhingran, Anuja, Kelly, Patrick, Iyer, Revathy B., Levenback, Charles F., Zhang, Yongbin, Dong, Lei, & Klopp, Ann, E-mail: aklopp@mdanderson.org. Anatomic Distribution of Fluorodeoxyglucose-Avid Para-aortic Lymph Nodes in Patients With Cervical Cancer. United States. doi:10.1016/J.IJROBP.2012.11.032.
Takiar, Vinita, Fontanilla, Hiral P., Eifel, Patricia J., Jhingran, Anuja, Kelly, Patrick, Iyer, Revathy B., Levenback, Charles F., Zhang, Yongbin, Dong, Lei, and Klopp, Ann, E-mail: aklopp@mdanderson.org. Fri . "Anatomic Distribution of Fluorodeoxyglucose-Avid Para-aortic Lymph Nodes in Patients With Cervical Cancer". United States. doi:10.1016/J.IJROBP.2012.11.032.
@article{osti_22420312,
title = {Anatomic Distribution of Fluorodeoxyglucose-Avid Para-aortic Lymph Nodes in Patients With Cervical Cancer},
author = {Takiar, Vinita and Fontanilla, Hiral P. and Eifel, Patricia J. and Jhingran, Anuja and Kelly, Patrick and Iyer, Revathy B. and Levenback, Charles F. and Zhang, Yongbin and Dong, Lei and Klopp, Ann, E-mail: aklopp@mdanderson.org},
abstractNote = {Purpose: Conformal treatment of para-aortic lymph nodes (PAN) in cervical cancer allows dose escalation and reduces normal tissue toxicity. Currently, data documenting the precise location of involved PAN are lacking. We define the spatial distribution of this high-risk nodal volume by analyzing fluorodeoxyglucose (FDG)-avid lymph nodes (LNs) on positron emission tomography/computed tomography (PET/CT) scans in patients with cervical cancer. Methods and Materials: We identified 72 PANs on pretreatment PET/CT of 30 patients with newly diagnosed stage IB-IVA cervical cancer treated with definitive chemoradiation. LNs were classified as left-lateral para-aortic (LPA), aortocaval (AC), or right paracaval (RPC). Distances from the LN center to the closest vessel and adjacent vertebral body were calculated. Using deformable image registration, nodes were mapped to a template computed tomogram to provide a visual impression of nodal frequencies and anatomic distribution. Results: We identified 72 PET-positive para-aortic lymph nodes (37 LPA, 32 AC, 3 RPC). All RPC lymph nodes were in the inferior third of the para-aortic region. The mean distance from aorta for all lymph nodes was 8.3 mm (range, 3-17 mm), and from the inferior vena cava was 5.6 mm (range, 2-10 mm). Of the 72 lymph nodes, 60% were in the inferior third, 36% were in the middle third, and 4% were in the upper third of the para-aortic region. In all, 29 of 30 patients also had FDG-avid pelvic lymph nodes. Conclusions: A total of 96% of PET positive nodes were adjacent to the aorta; PET positive nodes to the right of the IVC were rare and were all located distally, within 3 cm of the aortic bifurcation. Our findings suggest that circumferential margins around the vessels do not accurately define the nodal region at risk. Instead, the anatomical extent of the nodal basin should be contoured on each axial image to provide optimal coverage of the para-aortic nodal compartment.},
doi = {10.1016/J.IJROBP.2012.11.032},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 4,
volume = 85,
place = {United States},
year = {Fri Mar 15 00:00:00 EDT 2013},
month = {Fri Mar 15 00:00:00 EDT 2013}
}