Impact of lymphoceles on organ at risk doses in patients undergoing adjuvant pelvic radiation for carcinoma cervix
Purpose: Lymphoceles form part of target volume during adjuvant radiation for cervical cancer. The impact of lymphocele on doses to adjacent organs at risk (OAR) has not been studied. The present study was designed to investigate the same.
Methods: From January 2011- December 2013 all patients were evaluated for presence of postoperative lymphocele. Planned target volume (PTV) was generated with and without lymphocele volume. Intensity modulated radiation therapy (IMRT) plans were generated and dose to OARs was determined. The impact of lymphocele volume on OAR dose was determined by Spearman rank test and Wilcoxon sign rank sum test was performed to determine the impact of lymphocele on OAR dose.
Results: A total of 11/93 patients had postoperative lymphoceles. Of these 63% were located in internal iliac region. The median lymphocele volume at simulation was 42.8 cc (range 6.4-105cc) and remained almost stable at 44 cc (range 3-100 cc) at fifth week of radiation. Negative correlation was observed between mean lymphocele volume and dose to bladder, rectum and bowel bag. Presence of lymphocele led to reduction in V30 and V40 of bladder (84 cc vs 77 cc, p = 0.004; 68 cc vs 63 cc; p = 0.01) and rectum (87 cc vs 80 cc, p = 0.0001; 73.5 cc vs 65 cc, p = 0.01) and V15 of bowel bag (843 cc vs 804 cc; p = 0.01).
Conclusion: Presence of lymphoceles displaced OARs leading to reduction in high dose volumes of rectum and bladder.
Kim HY, Kim JW, Kim SH, et al. An analysis of the risk factors and management of lymphocele after pelvic lymphadenectomy in patients with gynecologic malignancies. Cancer Res Treat 2004; 36:377-83.
Mori N. Clinical and experimental studies on the so-called lymphocyst which develops after radical hysterectomy in cancer of the uterine cervix. J Jpn Obstet Gynecol Soc 1955; 2:178-203.
Gray MJ, Plentl AA, Taylor HC Jr. The lymphocyst: a complication of pelvic lymph node dissections. Am J Obstet Gynecol 1958; 75:1059-62.
Tam KF, Lam KW, Chan KK, Ngan HY. Natural history of pelvic lymphocysts as observed by ultrasonography after bilateral pelvic lymphadenectomy. Ultrasound Obstet Gynecol 2008; 32:87-90.
Metcalf KS, Peel KR. Lymphocele. Ann R Coll Surg Engl 1993; 75:387-92.
Small W Jr, Mell LK, Anderson P, et al. Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy in postoperative treatment of endometrial and cervical cancer. Int J Radiat Oncol Biol Phys 2008; 71:428-34.
Chopra S, Engineer R, Mahantshetty U, et al. Protocol for a phase III randomised trial of image-guided intensity modulated radiotherapy (IG-IMRT) and conventional radiotherapy for late small bowel toxicity reduction after postoperative adjuvant radiation in Ca cervix. BMJ Open 2012; 2pii: e001896.
Rutledge F, Dodd GD Jr, Kasilag FB Jr. Lymphocysts; a complication of radical pelvic surgery. Am J Obstet Gynecol 1959; 77:1165-75.
Conte M, Panici PB, Guariglia L, et al. Pelvic lymphocele following radical para-aortic and pelvic lymphadenectomy for cervical carcinoma: incidence rate and percutaneous management. Obstet Gynecol 1990; 76:268-71.
Dodd GD, Rutledge F, Wallace S. Postoperative pelvic lymphocysts. Am J Roentgenol Radium Ther Nucl Med 1970; 108:312-23.
Cantrell CJ, Wilkinson EJ. Recurrent squamous cell carcinoma of the cervix within pelvic-abdominal lymphocysts. Obstet Gynecol 1983; 62:530-4.
This work is licensed under a Creative Commons Attribution 3.0 License.
International Journal of Cancer Therapy and Oncology (ISSN 2330-4049)
© International Journal of Cancer Therapy and Oncology (IJCTO)
To make sure that you can receive messages from us, please add the 'ijcto.org' domain to your e-mail 'safe list'. If you do not receive e-mail in your 'inbox', check your 'bulk mail' or 'junk mail' folders.