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 (n = 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.
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.
Fuchshuber PR, Rodriguez-Bigas M, Weber T, Petrelli NJ. Anal cancer and perianal epidermoid cancers. J Am Coll Surg. 1997;185:494–505. PubMed
Wade DS, Herrera L, Castillo NB, Peterelli NJ. Metastases to the lymph nodes in epidermoid carcinoma of the anal canal studied by a clearing technique. Surg Gynecol Obstet. 1989;169:238–42. PubMed
Mäkelä PJ, Leminen A, Kääriäinen M, Lehtovirta P. Pretreatment sonographic evaluation of inguinal lymph nodes in patients with vulvar malignancy. J Ultrasound Med. 1993;5:255–8.
Ross AS, Schmults CD. Sentinel lymph node biopsy in cutaneous squamous cell carcinoma: a systematic review of the English literature. Dermat Surg. 2006;32:1309–21. CrossRef
Sobin LH, Wittekind C. TNM Classification of Malignant Tumors. New York: Wiley-Liss, 2002.
Roelofsen F, Bartelink H. Combined treatment of anal carcinoma. Oncologist. 1998;3:413–8. PubMed
Mitchell SE, Mendenhall WM, Zlotecki RA, Carroll RR. Squamous cell carcinoma of the anal canal. Int J Radiat Oncol Biol Phys. 2000;49:1007–13.
Meyerson RJ, Kong F, Birnbaum EH, Fleshman JW, Kodner IJ, Picus J, et al. Radiation therapy for epidermoid carcinoma of the anal canal, clinical and treatment factors associated with outcome. Radiotherapy Oncol. 2001;61:15–22. CrossRef
Peley G, Farkas E, Sinkovics I, Kovacs T, Keresztes S, Orosz Z, et al. Inguinal sentinel lymph node biopsy for staging anal cancer. Scand J Surg. 2002;91:336–8. PubMed
Bobin JY, Gérard JP, Chapet O, Romestaing P, Isaac S. Lymphatic mapping and inguinal sentinel lymph node biopsy in anal cancers to avoid prophylactic inguinal irradiation. Cancer Radiother. 2003;7:85s–90s. PubMed
Mistrangelo M, Bello M, Mobiglia A, Beltramo G, Cassoni P, Milanesi E, et al. Feasibility of the sentinel node biopsy in anal cancer. Q J Nucl Med Mol Imaging. 2009;53:3–84. PubMed
Gretschel S, Warnick P, Bembenek A, Dresel S, Koswig S, String A, et al. Lymphatic mapping and sentinel lymph node biopsy in epidermoid carcinoma of the anal canal. Eur J Surg Oncol. 2008;34:890–4. PubMed
Kroon BBK, Horenblas S, Deurloo EE, Nieweg OE, Teerstra HJ. Ultrasonography-guided fine-needle aspiration cytology before sentinel node biopsy in patients with penile carcinoma. BJU. 2004;95:517–21.
- 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
MD, PhD Johannes S. de Jong
MD Jannet C. Beukema
Md, PhD Gooitzen M. van Dam
MD, PhD Riemer Slart
Md, PhD Theo Wiggers
Neu im Fachgebiet Chirurgie
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