Challenging the conventional treatment of colon cancer by sentinel lymph node mapping and its role of detecting micrometastases for adjuvant chemotherapy
| Autor: | Sandeep Singh Grewal, Madan L. Arora, David Wiese, Mohamed H. Elgamal, Kiran Devisetty, T. Singh, Meghan Cherry, Sunil Kaushal, Sukamal Saha, David Eilender, Suresh Mukkamala, Mustafa Alnounou, Swetha Pentapati, Robin Buttar |
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| Rok vydání: | 2018 |
| Předmět: |
0301 basic medicine
Cancer Research medicine.medical_specialty Colorectal cancer medicine.medical_treatment Sentinel lymph node Disease 03 medical and health sciences 0302 clinical medicine Surgical oncology Internal medicine Medicine Humans Stage (cooking) Lymph node Neoplasm Staging Chemotherapy Hematology business.industry Sentinel Lymph Node Biopsy General Medicine medicine.disease 030104 developmental biology medicine.anatomical_structure Oncology Chemotherapy Adjuvant Neoplasm Micrometastasis 030220 oncology & carcinogenesis Lymphatic Metastasis Colonic Neoplasms Radiology Neoplasm Recurrence Local Sentinel Lymph Node business |
| Zdroj: | Clinicalexperimental metastasis. 35(5-6) |
| ISSN: | 1573-7276 |
| Popis: | All colon cancer patients with lymph node (LN) positive disease are treated with chemotherapy. Patients with node negative disease are usually cured by surgery alone. Yet about 20% of patients develop recurrence within 5 years despite node negative status. This may often be the result of missed micrometastases by conventional examination. Sentinel lymph node (SLN) mapping was developed to find those nodes detected by blue dye which was ultrastaged to detect micrometastases. Consecutive patients, underwent SLN mapping with the blue dye with success rate of 99.2%. Average number of LN was 18.3, average number of SLN was 3/patient and overall nodal positivity was 45%. Ten patients had skip metastases. Overall survival of 235 patients was 84 months with survival of node negative patients 97 months versus 68 months for node positive patients. For stage I–IV patients, overall survival was as follows: stage I—115 months, stage II—90 months, stage III—84 months and stage IV—24 months respectively. Patients with micrometastases after chemotherapy had average survival of 108 months versus those without chemotherapy was 50 months. Thus, SLN mapping techniques is highly successful, easily reproducible and finds micrmoetastases in over 15% of patients which could have been missed by conventional pathological examination. These patients when treated with adjuvant chemotherapy have similar survival as those of node negative disease. Similarly, patients without any nodal metastases after SLN mapping and ultrastaging, may be considered as true node negative disease and may avoid further adjuvant chemotherapy. |
| Databáze: | OpenAIRE |
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