![]() ![]() Peritoneal hyperthermic perfusion has been used to concentrate drugs locally, and this can augment the antitumor response in retroperitoneal metastatic lymph nodes. It is difficult to maintain high concentrations of chemotherapies in the pelvic and abdominal lymph nodes, and systemic chemotherapy has little or no treatment effect. Since the location of the retroperitoneal lymph nodes is deep and concealed, conventional surgical resection is difficult. These symptoms can severely affect the patients’ quality of life. Retroperitoneal metastatic lymph nodes often cause a series of serious clinical symptoms, such as abdominal pain, bloating, jaundice, loss of appetite, and radiating pain in the lower back. The retroperitoneum is adjacent to vital organs and structures, such as the pancreas, duodenum, ureter, large blood vessels, and nerves. Therefore, the retroperitoneal lymph nodes are the most common sites of metastasis for cancers, such as esophageal, gastric, hepatic, pancreatic, colorectal, ovarian, and cervical cancers. Malignant tumors in the abdominal cavity, lower limbs, and other parts of the body can metastasize to the retroperitoneum via the lymphatic circulation. Better preoperative planning, intraoperative implementation, better choice of puncture path, and selection of appropriate tumor size are important factors that can improve the clinical efficacy of 125I brachytherapy for retroperitoneal metastatic lymph nodes. ConclusionĬT-guided 125I brachytherapy is an optional palliative treatment modality for retroperitoneal metastatic lymph nodes, which can provide high local control without severe complications. The Cox proportional hazards model suggested that lymph nodes invaded the large vessels visible on images, maximum diameter and puncture path were independent risk factors for LTPFS. A maximum diameter ≤ 3 cm (P-0.031) or 3–5 cm (P-0.018) were also associated with significantly better LTPFS than a maximum diameter ≥ 5 cm. Puncture path through abdominal wall or paravertebral approach were also associated with better LTPFS than a hepatic approach ( P < 0.05). ![]() Necrotic lymph nodes ( p < 0.001), fusion (p-0.003), and invasion of vessels visible on images ( p < 0.001) were associated with poor LTPFS. Metastatic lymph node with uniform density (p-0.009), clear boundaries (p-0.011), regular morphology ( P < 0.001), and < 3 organs at risk of metastasis (p-0.020) were associated with better LTPFS. A layered Cox proportional hazards model was established to filter out the independent factors affecting local tumor progression-free survival (LTPFS). We retrospectively evaluated 92 patients received 125I brachytherapy for retroperitoneal metastatic lymph nodes. This study was designed to explore the clinical efficacy and prognostic factors of CT-guided 125I brachytherapy for the treatment of retroperitoneal metastatic lymph nodes. Lymph nodes 3.5cm and larger are more likely to be malignant, however in differential diagnosis of small lymph nodes (1 cm in length) they were noT statistically significant difference between the pathologic and benign lymph nodes.Due to the unique anatomical location of retroperitoneal metastatic lymph nodes, current treatment options are limited. EUS-FNA can detect positive lymph nodes as small as 1 cm, however, this method can also miss positive lymph nodes up to size of 3.5 cm which probably due to the uneven involving of the nodes by tumor cells. Positive predictive value (PPV) is 100% and negative predictive value (NPV) is 78.7%. Sensitivity of the procedure is 45.8% and, specificity is 100%. 2(1%) of 74 cases had atypical diagnosis, 5(7%) cases were unsatisfactory due to inadequate material obtained during procedure. 42 of 74 patients (57%) had negative fine-needle aspiration diagnosis: 40 patients had reactive lymph node diagnosis, 2 patients had granulomatous inflammation diagnosis. The types of neoplasia detected were lymphoma (3), metastatic adenocarcinoma (16), metastatic acinar cell carcinoma (1) and metastatic neuroendocrine tumor (5). 25 of the 74 (34%) patients had malignant diagnosis. ![]()
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