Lateral Lymph Nodes in Rectal Cancer: Do we all Think the Same? A Review of Multidisciplinary Obstacles and Treatment Recommendations

Lateral lymph nodes in low, locally advanced, rectal cancer have proven implications for local recurrence rates, which increase drastically in the presence of persistently enlarged lateral lymph nodes. These clinical implications warrant a thorough understanding of lateral nodal disease with awareness and knowledge from all three specialties involved – radiology, radiation oncology, and surgery – to ensure proper treatment. Relevant literature for each specialty, including all current guidelines and perspectives, were examined. Variations in definitions and treatment paradigms were evaluated. There is still no consensus for the standardized treatment of lateral nodal disease. Each discipline works according to their own available evidence, but relevant data are scarce. Current international guidelines and standard recommendations for the diagnostics and treatment of lateral lymph nodes are lacking. This results in differing perspectives and interpretations between the disciplines which can lead to challenging communication in an area where multidisciplinary collaboration is essential. This review addresses this by presenting the current evidence, perspectives and practices of each specialty and makes suggestions for each phase of the diagnostic and treatment process for patients with lateral nodal disease. By doing this, steps are taken toward achieving international consensus, and multidisciplinary collaboration.     

A guide to oral vaccination: Highlighting electrospraying as a promising manufacturing technique toward a successful oral vaccine development

Most vaccines approved by regulatory bodies are administered via intramuscular or subcutaneous injections and have shortcomings, such as the risk of needle-associated blood infections, pain and swelling at the injection site. Orally administered vaccines are of interest, as they elicit both systemic and mucosal immunities, in which mucosal immunity would neutralize the mucosa invading pathogen before the onset of an infection. Hence, oral vaccination can eliminate the injection associated adverse effects and enhance the person's compliance. Conventional approaches to manufacturing oral vaccines, such as coacervation, spray drying, and membrane emulsification, tend to alter the structural proteins in vaccines that result from high temperature, organic and toxic solvents during production. Electrohydrodynamic processes, specifically electrospraying, could solve these challenges, as it also modulates antigen release and has a high loading efficiency. This review will highlight the mucosal immunity and biological basis of the gastrointestinal immune system, different oral vaccine delivery approaches, and the application of electrospraying in vaccines development.     

L’exploration axillaire en pratique quotidienne dans le parcours diagnostique d’un cancer du sein<br/>Axillary staging in daily practice in the diagnosis of breast cancer

When a breast cancer is diagnosed, the quality of the evaluation before treatment is essential to guide the therapeutic decision. The staging axillary is necessary because it estimates the regional extension of the disease, which makes it a paramount prognosis factor. Some different preoperative medical imaging can reveal metastasis axillary nodes. However, the axillary ultrasound remains the reference imaging and it also leads the biopsies too. Since theACOSOG-Z0011 trial, we are facing a therapeutic deescalation in the axillary surgery. According to recent results, we can note that the position of the axillary imaging is more and more important. The purpose of the ultrasound is to avoid a two-stage dissection after a positive sentinel lymph node when the ACOSOG-Z0011 criteria are not met.

Résumé
Lors de la découverte d’un cancer du sein, la qualité du bilan préthérapeutique est essentielle afin d’orienter la décision thérapeutique. L’exploration axillaire est primordiale, car elle évalue l’extension régionale de la maladie, ce qui en fait un des facteurs pronostiques majeurs. Différents examens d’imagerie préopératoires peuvent révéler une atteinte de ces ganglions axillaires. Cependant, l’imagerie de référence reste l’échographie axillaire, qui permet également de guider des prélèvements. Depuis l’étude ACOSOGZ0011, nous sommes face à une désescalade thérapeutique de la chirurgie axillaire. Selon des résultats récents, on constate que la place de l’imagerie axillaire est encore plus importante. Le but de l’échographie est d’éviter un curage en deux temps après un ganglion sentinelle positif lorsque les critères de l’ACOSOG-Z0011 ne sont pas remplis.     

MRI evaluation of axillary and intramammary lymph nodes in the postoperative period

Our study aimed to evaluate if breast‐conserving surgery and adjuvant treatment could affect the morphological features of axillary and intramammary lymph nodes on magnetic resonance imaging (MRI) in patients with invasive breast cancer and clinically negative axilla. In this single‐center study, we retrospectively evaluated 50 patients who had (a) breast‐conserving surgery, (b) clinically negative axilla, (c) preoperative MRI within 3 months before surgery, and (d) postoperative MRI within 12 months after surgery. Axillary and intramammary lymph nodes on postoperative MRI were identified and then compared with preoperative MRI by two breast radiologists with regards to the following: enlargement, cortical thickening, presence of fatty hilum, irregularity, heterogeneity, matting, and axillary lymph node asymmetry. Three hundred and two axillary and eight intramammary lymph nodes were evaluated. Enlargement and cortical thickening were seen in 5/50 (10%) patients in three axillary and two intramammary lymph nodes. None of the lymph nodes on postoperative MRI demonstrated occurrence of lack of fatty hilum, irregularity, heterogeneity, matting or axillary lymph node asymmetry. No evidence of recurrence was observed on 2‐year follow‐up. Lymph node enlargement and cortical thickening may be observed in a few patients in the postoperative period. Nevertheless, in patients with clinically negative axilla, these changes in morphology are often related to treatment rather than malignancy and favor short‐term follow‐up as an alternative to lymph node biopsy.     

甲状腺乳头状癌合并颈部局灶型Castleman病1例

摘要：目的探讨甲状腺乳头状癌(PTC)合并颈部局灶型Castleman病 (UCD)的临床诊治经验。方法回顾性分析1 例PTC合并颈部UCD的临床病例资料，并检索国内外文献。该患者术前行甲状腺结节穿刺细胞学检查(FNA)倾向PTC，合并右颈侧区淋巴结肿大，行甲状腺右侧腺叶合并峡部切除及右颈II、III、IV、VI区淋巴结清扫术。结果术后切口愈合良好，无声音嘶哑及低钙症状，术后 4 d治愈出院。术后随访6个月无复发。术后病理证实颈侧区肿大淋巴结为UCD。结论PTC合并UCD极为罕见，且UCD的术前诊断较为困难，但手术切除多可治愈；PTC合并颈部淋巴结肿大者，临床医生不仅需考虑甲状腺癌转移淋巴结可能，还需警惕UCD的存在。     

电针傍刺经筋结点治疗缺血性脑卒中急性期上肢偏瘫的临床研究

目的通过观察电针傍次上肢经筋结点治疗缺血性脑卒中急性期上肢偏瘫的临床疗效,探讨电针傍次经筋结点治疗缺血性卒中急性期肢体瘫痪的作用机制。方法60例缺血性卒中急性期偏瘫的患者采用SPSS软件随机数字生成器分为治疗组与对照组各30例。治疗组采用电针傍刺上肢经筋结点治疗,对照组采用电针上肢常规经穴治疗。分别于治疗前后观察评价两组上肢的肌力(MMT徒手肌力评定法)、关节活动度(ROM关节活动度评定法)、运动功能(Fugl-Meyer运动功能评分量表、ARAT上肢动作研究量表)、临床神经功能缺损程度(NIHSS量表)确定疗效。结果两组患者治疗后ROM评分下降,Barthel指数、Fugl-Meyer评分、ARAT评分均上升。治疗组较对照组ROM评分、Barthel指数、Fugl-Meyer评分、ARAT评分改善更优(P<0.05);疗程结束后治疗组肌力经MMT评定后有效率为90%,高于对照组的76.67%(P<0.05);治疗组疗效经神经功能缺损程度评价有效率为93.33%,高于对照组76.67%(P<0.05)。结论电针傍刺经筋结点与常规针刺治疗都可以改善缺血性卒中急性期上肢瘫痪,但电针傍刺经筋结点治疗效果更佳。     

Elective Nodal Irradiation for Limited-stage Small-cell Lung Cancer: Survey of US Radiation Oncologists on Practice Patterns

BackgroundTraditionally, elective nodal irradiation (ENI) has been used in clinical trials that have established thoracic radiotherapy as instrumental in improving survival for patients with limited-stage small-cell lung cancer (LS-SCLC). However, several reports have suggested that the omission of ENI might be appropriate. Current US practice patterns are unknown regarding ENI for patients with LS-SCLC.Materials and MethodsWe surveyed US radiation oncologists via an institutional review board-approved questionnaire. The questions covered demographics, treatment recommendations, and self-assessed knowledge of key clinical trials. χ² and Cochran-Armitage tests were used to evaluate for statistically significant correlations between responses.ResultsWe received 309 responses. Of the respondents, 21% recommended ENI for N0 LS-SCLC, 29% for N1, and 30% for N2; 64% did not recommend ENI for any of these clinical scenarios. The respondents who recommended ENI were more likely to have been practicing for > 10 years (P < .001), more likely to be in private practice (P = .04), and less likely to be familiar with the ongoing Cancer and Leukemia Group B 30610 trial (P = .04). Almost all respondents (93%) prescribed the same radiation dose to the primary disease and involved lymph nodes. When delivering ENI, 36% prescribed the same dose to the involved and elective nodes, and 64% prescribed a lower dose to the elective nodes.ConclusionNearly two thirds of respondents did not recommend ENI, which represents a shift in practice. A recent large clinical trial that omitted ENI reported greater overall survival than previously reported and lower-than-expected radiation toxicities, lending further evidence that omitting ENI should be considered a standard treatment strategy.