Department of Nuclear Medicine, Karolinska University Hospital, C1-46, SE-141 86 Huddinge, Stockholm, Sweden.
Department of Clinical Science, Intervention and Technology, Division of Radiology, Karolinska Institutet, C1:46, Huddinge, S-141 86, Stockholm, Sweden.
Cancer Imaging. 2018 Dec 18;18(1):53. doi: 10.1186/s40644-018-0185-1.
In current best practise, curatively intended treatment for oesophageal cancer usually consists of neoadjuvant chemo-radiotherapy (nCRT) or perioperative chemotherapy, and oesophagectomy. Sentinel Lymph Node Biopsy (SLNB) has the potential to identify patients without lymph node metastases and thus improve the staging accuracy and influence treatment. The impact of neoadjuvant treatment on the lymphatic drainage of oesophageal cancers and subsequently the SLNB procedure in this tumour type has previously not been well studied.
To evaluate changes in lymphatic drainage patterns of the tumour in patients with cancer of the oesophagus or gastro-oesophageal junction (GOJ) using Sentinel Lymph Node (SLN) hybrid SPECT/CT lymphoscintigraphy before and after nCRT.
Patients with clinical stage T2-T3, any N-stage, M0 cancer of the oesophagus or GOJ underwent endoscopically guided peri-/intratumoral injection of radio-colloid followed by hybrid SPECT/CT lymphoscintigraphy prior to, and once again following, nCRT. SPECT/CT images were evaluated to number and location of SLNs and compared between the two examinations.
Ten patients were included in this pilot trial. SPECT/CT lymphoscintigraphy was performed in twenty procedures. The same Sentinel Lymph Node station before and after nCRT was observed in one single patient. In two patients, no SLN was detected before nCRT. In three patients no SLN was detected following nCRT. In four patients, the SLN stations were not the same station at baseline compared to follow-up examination.
The reproducibility SLN detection in patients with cancer of the oesophagus/GOJ following nCRT was very poor. nCRT appears to alter lymphatic drainage patterns and thus may affect detection of SLNs and potentially also the accuracy of an SLNB in these patients. On the basis of these initial results, we abort further patient recruitment in our institution.
Australian New Zealand Clinical Trials Registry (ANZCTR). Identifier ACTRN12618001433291 . Date registered: 27/08/2018. Retrospectively registered.
在目前的最佳实践中，对食管癌的有治愈意图的治疗通常包括新辅助放化疗（nCRT）或围手术期化疗和食管切除术。前哨淋巴结活检（SLNB）有可能识别无淋巴结转移的患者，从而提高分期准确性并影响治疗。以前，新辅助治疗对食管癌的淋巴引流以及随后在这种肿瘤类型中的 SLNB 程序的影响尚未得到很好的研究。
使用前哨淋巴结（SLN）混合 SPECT/CT 淋巴闪烁显像术在 nCRT 前后评估食管或胃食管交界处（GOJ）癌症患者肿瘤淋巴引流模式的变化。
临床分期为 T2-T3、任何 N 期、M0 期的食管或 GOJ 癌症患者在内镜引导下进行放射性胶体经皮/腔内注射，然后在 nCRT 前和 nCRT 后进行混合 SPECT/CT 淋巴闪烁显像术。评估 SPECT/CT 图像以确定 SLN 的数量和位置，并在两次检查之间进行比较。
本试验共纳入 10 例患者，共进行了 20 次 SPECT/CT 淋巴闪烁显像术。在一名患者中，nCRT 前后观察到相同的前哨淋巴结站。在 2 例患者中，nCRT 前未检测到 SLN。在 3 例患者中，nCRT 后未检测到 SLN。在 4 例患者中，与随访检查相比，基线时 SLN 站不是同一站。
在接受 nCRT 的食管/GOJ 癌症患者中，SLN 检测的可重复性非常差。nCRT 似乎改变了淋巴引流模式，因此可能会影响 SLN 的检测，并可能影响这些患者的 SLNB 的准确性。基于这些初步结果，我们在我们的机构中止了进一步的患者招募。
澳大利亚和新西兰临床试验注册中心（ANZCTR）。标识符 ACTRN12618001433291。注册日期：2018 年 8 月 27 日。回顾性注册。
