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. 2018 Nov-Dec;23(6):503-509.
doi: 10.1016/j.rpor.2018.05.008. Epub 2018 Jun 12.

Lymph flow guided irradiation of regional lymph nodes in patients with cervical cancer: Preliminary analysis of scintigraphic data

Sergey Nikolaevich Novikov  1 , Pavel Ivanovich Krzhivitskii  1 , Sergey Vasilevich Kanaev  2 , Igor Viktorovitch Berlev  3 , Margarita Viktorovna Kargopolova  1 , Zaur Ibragimov  3 , Mikhail Bisyarin  1 , Valentina Vladimirovna Saveleva  1
Affiliations

Lymph flow guided irradiation of regional lymph nodes in patients with cervical cancer: Preliminary analysis of scintigraphic data

Sergey Nikolaevich Novikov et al. Rep Pract Oncol Radiother. 2018 Nov-Dec.

Abstract

Purpose: To evaluate patterns of lymph flow from primary lesions in patients with cervical cancer and to determine how useful for radiotherapy planning this information can be.

Materials and methods: SPECT-CT visualization of sentinel (SLN) lymph nodes (LNs) was performed in 36 primary patients with IB-IIB cervical cancer. The acquisition started 120-240 min after 4 peritumoral injections of 99mTc-radiocolloids (150-300 MBq in 0.4-1 ml). We determined localization of LN with uptake of radiocolloids, type of lymph flow (mono-, bi-lateral) and lymph flow patterns (supraureteral paracervical, infraureteral paracervical and directly to para-aortic LNs).

Results: SLNs were visualized in 31 of 36 women. Bilateral lymph-flow was detected in 22 (71%), monolateral - in the other 9 (29%) cases. The distribution of SLNs was as follows: external iliac - 64.5%, internal iliac - 54.8%, obturator - 32.2%, common iliac - 35.5% and pre-sacral 3.2%. Para-aortic LNs were visualized in 5 (16.1%) patients. The supraureteral paracervical pattern of lymph flow was identified in 22, infraureteral paracervical - in 4 and their combination - in the other 5 women.

Conclusion: Visualization of an individual pattern of lymph flow from primary cervical cancer can be considered as a promising tool for optimization of the volume of irradiated regional LNs.

Keywords: Cervical cancer; Lymph flow; Radiotherapy; SPECT–CT; Sentinel lymph nodes.

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Figures

Fig. 1
Fig. 1
Sentinel lymph nodes with uptake of 99mTc-radiocolloids: (a) obturator, (b) external iliac, (c) internal iliac, (d) presacral, (e) common iliac, (f) para-aortic.
Fig. 2
Fig. 2
Lymph flow patterns and topography of the regional lymph nodes in patients with cervical cancer: 1. obturator, 2. external iliac, 3. internal iliac, 4. presacral, 5. common iliac, 6. para-aortic, 7. inguinal; solid lines – main routes of lymph flow from the cervix; dotted lines – possible routes that we were not able to visualize in our patients.
Fig. 3
Fig. 3
Bilateral and unilateral patterns of lymph flow from the cervical cancer: (a) unilateral lymph flow pattern with 99mTc-radiocolloids uptake in the left external iliac, common iliac and para-aortic lymph nodes. (b) Bilateral lymph flow with 99mTc-radiocolloids uptake in the left and right obturator lymph nodes.
Fig. 4
Fig. 4
Topography of visualized lymph nodes in patients with cervical cancer: obturator – in 10 (32.2%), external iliac – in 20 (64.5%), internal iliac – in 17 (54.8%), presacral – in 1 (3.2%), common iliac – in 11 (35.5%), para-aortic – in 5 (16.1%) cases.
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