单极射频在面部年轻化治疗中的疗效观察

目的：观察单极射频在面部年轻化治疗中的应用效果。方法：20例面部老化者接受单极射频紧肤除皱治疗,分别在治疗前及治疗后2个月和6个月进行面部三维扫描,重建面部三维模型,利用逆向工程软件测定治疗后不同时间点的面部提升度、鼻唇沟提升度及眉上提度。结果：Thermage面部紧肤治疗后2个月和6个月,同治疗前相比面部整体分别提升1．080mm、2．282mm,鼻唇沟深度分别提升1．150mm、2．293mm,眉上提分别为1．174mm、2．300mm。结论：单极射频是一种有效、无创的面部年轻化治疗方法,具有l临床应用前景。     

Bipolar radiofrequency ablation of spinal tumors: predictability,safety and outcome

BackgroundBone metastases are often the cause of tumor-associated pain and reduction of quality of life. For patients that cannot be treated by surgery, a local minimally invasive therapy such as radiofrequency ablation can be a useful option. In cases in which tumorous masses are adjacent to vulnerable structures, the monopolar radiofrequency can cause severe neuronal damage because of the unpredictability of current flow.PurposeThe aim of this study is to show that the bipolar radiofrequency ablation provides an opportunity to safely treat such spinal lesions because of precise predictability of the emerging ablation zone.Study designProspective cohort study of 36 patients undergoing treatment at a single institution.Patient sampleThirty-six patients in advanced tumor stage with primary or secondary tumor involvement of spine undergoing radiofrequency ablation.Outcome measuresPrediction of emerging ablation zone. Clinical outcome of treated patients.MethodsX-ray–controlled treatment of 39 lesions by bipolar radiofrequency ablation. Magnetic resonance imaging was performed pre- and postinterventionally. Patients were observed clinically during their postinterventional stay.ResultsThe extent of the ablation zones was predictable to the millimeter because it did not cross the peri-interventional planned dorsal and ventral boundaries in any case. No complications were observed.ConclusionsAblation of tumorous masses adjacent to vulnerable structures is feasible and predictable by using the bipolar radiofrequency ablation. Damage of neuronal structures can be avoided through precise prediction of the ablation area.     

An Open-label Study Assessing the Efficacy and Tolerability of a Post-treatment Skincare Protocol Following Radiofrequency Microneedling for Facial Rejuvenation

BackgroundA post-treatment skincare protocol (Finishing Touch™ Protocol; Colorescience®, Inc.) comprising several commercial products was developed for use after minimally invasive facial procedures.ObjectiveOur objective was to assess the effect of this post-treatment protocol on subject experiences following radiofrequency microneedling including confidence to resume normal activities, treatment satisfaction and likelihood for retreatment. MethodsHealthy female subjects, aged 21 to 65 years with Fitzpatrick Skin Types I to IV seeking facial rejuvenation with radiofrequency microneedling were enrolled (N=29). The microneedling procedure was performed during the baseline visit. Digital images were obtained before and immediately following microneedling, and after post-procedure application of the skincare protocol. A nonmedicated barrier ointment was also applied prior to the skincare protocol immediately following treatment in a third group of subjects. Subsequently, the skincare protocol was applied each morning after regular skincare routines. Subjects returned after four weeks for a final assessment, a self-assessment questionnaire, and treatment satisfaction ratings.ResultsFollowing skincare protocol application, most subjects (97%) observed improvements in skin redness and/or treatment site marks, felt more confident (90%) and were very or extremely comfortable resuming normal activities (86%). Mild-to-moderate adverse events (n=4) resolved and were consistent with adverse events reported in the literature with no bleeding immediately following the microneedling with radiofrequency treatment.LimitationsPrimary limitations were the small number of subjects and self-reported outcomes.ConclusionBased on our results, the studied post-treatment skincare protocol appeared to improve subject confidence, comfort, satisfaction, and the likelihood of a repeat radiofrequency microneedling procedure among the included patients. No reported adverse events incremental to standard microneedling were observed.     

Inguinal lymph node presenting as the delayed site of metastasis in early stage endometrial carcinoma: Case report

IntroductionInguinal lymph nodes are the frequent sites of metastasis for malignant lymphoma, squamous cell carcinoma of anal canal, vulva and penis, malignant melanoma and squamous cell carcinoma of skin over lower extremities or trunk. Anatomically, endometrial carcinoma is less likely to spread to the superficial or deep inguinal lymph nodes, thus metastatic involvement of these lymph nodes can easily be overlooked.Case presentationHere-in we report a case of a 65-year old Saudi morbid obese female, who presented with left inguinal lymphadenopathy as initial delayed site of metastasis almost 19 months after the initial treatment for FIGO IA endometrial carcinoma. Patient underwent left inguinal lymph node dissection. Histopathology confirmed metastatic endometrial adenocarcinoma, positive for cytokeratin (CK-7), estrogen receptor (ER) and progesterone receptors (PR), negative for CK-20 and CDX2. Following the post-surgery recovery, she was given extended field radiation therapy to para-aortic, pelvis and bilateral inguinal lymph nodes with concurrent cisplatin chemotherapy followed by high dose rate brachytherapy.ConclusionInguinal lymph nodes as delayed site of metastasis in early endometrial carcinoma is extremely rare entity. Incorporation of FDG-PET during the preoperative screening of inguinal nodes may be helpful. The impact of lymph node dissection and adjuvant radiation therapy on survival needs to be established.     

Radiofrequency Ablation of Metastases from Renal Cell Carcinoma: Technique,Complications, and Midterm Outcome

ObjectivesTo determine the therapeutic effect of radiofrequency ablation of metastases from renal cell carcinoma (RCC) with respect to complications and local tumor control.MethodsSixty-six radiofrequency ablations under computed tomography (CT) fluoroscopy control were performed in 38 patients with metastatic RCC. The ablation was performed for local tumor volume reduction in 7 patients and for complete local tumor control in 31 patients. Sites of ablation included the liver (39), lung (11), kidney (11), adrenal glands (2), and lymph nodes or soft tissue (3). CT scanning was performed immediately after the ablation procedure and at 3, 6, 12,18, and 24 mo during the follow-up period. Size of the target lesion, ablation duration and temperature, and complications associated with the ablation procedure and rate of local recurrence were recorded.ResultsAt a mean follow-up of 10 mo (median: 12 mo; range: 3–47 mo), no complications were observed except two pneumothoraces that did not require further intervention. The average metastasis size was 7.9 cm in patients treated for volume reduction and 2.3 cm in patients treated for local tumor control. One local recurrence in the kidney, caused by incorrect needle placement during the ablation procedure, was detected on the first imaging control. The average ablation duration per metastasis was 11.5 min; a mean temperature of 70.5 °C was reached in the target lesion.ConclusionsPercutaneous radiofrequency ablation represents a safe treatment technique for metastases from RCC. Indications in selected patients may be both tumor volume reduction and complete ablation of the metastatic site.     

A Method for Treating Complications Developed Following Countour Correction with Calcium Hydroxylaptite-based Filler

BackgroundFillers based on calcium hydroxyapatite (CaHA) have become popular for the correction of involutive skin changes. However, if the filler injection technique is violated, undesirable events can occur in the skin, the treatment of which is complicated by the lack of a specific antidote to CaHA.ObjectiveIn this study, we aimed to evaluate the effectiveness of a combined method that includes a course of ultraphonophoresis of collagenase and diadynamophoresis of sodium thiosulfate (Na₂S₂O₃) for the treatment of complications developed after contour correction with CaHA-based fillers.MethodsThe study included 37 women aged 47.2±5.9 years old with a complication developed after the superficial injection of a CaHA-based filler localized in the facial area. The patients were divided into three groups; Group I received a course of ultraphonophoresis of collagenase (Collalysin 1000 CU); Group II received a course of diadynamophoresis of 30% Na₂S₂O₃; and Group III received a combined treatment.ResultsA combined course (Group III) had a significant effect expressed as a reduction of contouration, gel visualization, local edema, and neuropathy, as well as a stabilized psychoemotional condition of patients. This treatment complex significantly accelerates the biodegradation of the filler and exerts a restructuring effect.ConclusionThe application of this combined treatment course in patients with complications following the superficial injection of CaHA-based filler appears to be a highly effective treatment method, which was confirmed by the resolution of clinical symptoms, accelerated drug biodegradation, and an increase in the patients’ quality of life.     

Multipass Vector (Mpave) Technique with Nonablative Radiofrequency to Treat Facial and Neck Laxity

Background. Redundant facial and neck skin is a major feature of aging and historically has been corrected surgically. Recently, monopolar radiofrequency application has been introduced for nonablative tissue tightening of skin by volumetric heating of the deep dermis. It has been able to improve neck and cheek laxity and periorbital rhytides and to elevate eyebrows. However, questions remain as to the ideal parameters needed to optimize the use of radiofrequency.
Objective. To determine the safety and report on the efficacy of a radiofrequency application that involves a multipass vector (mpave) technique to target facial and neck skin laxity.
Methods. Twenty-five patients (skin types I to V) with mild to severe facial and neck laxity received one treatment session with monopolar radiofrequency. Treatment parameters, adverse events, and digital photographs were recorded. All patients were treated with a multipass vector technique consisting of four to five passes targeted over areas of skin that would most improve facial laxity. The multipass vector (mpave) treatment approach is described. Energy levels ranged from 62 to 91 J/cm2 per pulse.
Results. All patients experienced some immediate erythema and edema, which had completely resolved in most patients within 48 hours. No scarring or dyspigmentation was noted on follow-up at 6 and 12 weeks. Photographic analysis of pre- and post-treatment digital images revealed cosmetic improvement in facial and neck laxity in 96% of patients. The majority of patients demonstrated a moderate or better improvement. Stacked pulses in the submental region were shown to reduce fat.
Conclusions. The direct application of monopolar radiofrequency to facial and neck skin using a multipass vector (mpave) treatment approach was safely tolerated in patients of all skin types. Patient satisfaction correlated well with photographic analysis, and the technique was shown to be efficacious for most patients.     

Selective lymphadenectomy in patients with Merkel cell (cutaneous neuroendocrine) carcinoma

Background: Merkel cell carcinoma (MCC) is an aggressive cutaneous tumor with a propensity for local recurrence, regional and distant metastases. There are no well-defined prognostic factors that predict behavior of this tumor, nor are treatment guidelines well established. Methods: Staging of patients with a new diagnosis of MCC was attempted using selective lymphadenectomy concurrent with primary excision. Preoperative and intraoperative mapping, excision, and thorough histologic evaluation of the first lymph node draining the tumor primary site [sentinel node] was performed. Patients with tumor metastasis in the sentinel node underwent complete resection of the remainder of the lymph node basin. Results: Twelve patients underwent removal of 22 sentinel nodes. Two patients demonstrated metastatic disease in their sentinel lymph nodes, and complete dissection of the involved nodal basin revealed additional positive nodes. The node-negative patients received no further surgical therapy, with no evidence of recurrent local or regional disease at a maximum of 26 months follow-up (median 10.5 months). Conclusions: While the data are preliminary and initial follow-up is limited, early results suggest that sentinel lymph node mapping and excision may be a useful adjunct in the treatment of MCC. This technique may identify a population of patients who would benefit from further surgical lymph node excision.     

Outcome of Patients With Proximal Gastric Cancer Depends on Extent of Resection and Number of Resected Lymph Nodes

Background: Studies have shown that the survival of patients with gastric adenocarcinoma is related to the number of regional lymph nodes with metastases. The probability of identifying node-positive cancers increases with the number of lymph nodes resected and examined. It has been recommended that at least 15 lymph nodes be removed and examined for adequate staging. Prospective randomized studies have shown the lymph node yield is much greater with the D2 resection than the D1. This study evaluated the relative contribution of both the number of resected lymph nodes and the extent of gastric resection (D1/D2) on the outcome of patients with proximal gastric cancer.Methods: The medical records of 114 patients with adenocarcinoma of the proximal stomach, who underwent a curative gastric resection, were reviewed. Patients were stratified into four groups, i.e., two groups, D1/D1.5 and D2/D2.5, based on the extent of resection, and two groups based on the number of lymph nodes removed, fewer than 15 lymph nodes and 15 or more lymph nodes. Survival was determined by the method of Kaplan-Meier and differences compared by the log-rank test. Multivariate analysis was performed by using the Cox model.Results: The number of resected lymph nodes had no effect on the survival of the group as a whole. A significant improvement in survival was noted for patients with a D2 or greater resection. The median survival of patients with 15 or more lymph nodes resected improved from 25 months to 42 months when treated with an extended resection, (D2 or D2.5). Resection of 15 or more lymph nodes alone, or combined with an extended resection, resulted in a statistically significant improvement in survival for patients in American Joint Committee on Cancer Staging (AJCC) stage II.Conclusions: Both resection of 15 or more lymph nodes and extended lymphadenectomy contributed to the survival advantage observed in patients with AJCC stage II gastric cancer. The D2 gastric resection prolonged the median survival time and improved the 5-year survival rate for patients with 15 or more resected lymph nodes.Presented at the 52nd Annual Meeting of the Society of Surgical Oncology, Orlando, Florida, March 4–7, 1999.     

Head-to-head comparison of lymph node density and number of positive lymph nodes in stratifying the outcome of patients with lymph node-positive prostate cancer submitted to radical prostatectomy and extended lymph node dissection

ObjectiveThe aim of this study was to compare the predictive ability of lymph node density (LND) and number of positive lymph nodes in patients with prostate cancer and lymph node invasion.Materials and methodsWe included 568 patients with lymph node invasion treated with radical prostatectomy and extended pelvic lymph node dissection between January 1990 and July 2011 at a single center. The Kaplan-Meier method and multivariable Cox regression models tested the association between the number of positive lymph nodes or LND and cancer-specific survival (CSS). The predictive accuracy of a baseline model was assessed using Harrell's concordance index and then compared with that of a model including either the number of positive nodes or LND.ResultsThe median number of positive lymph nodes was 2, whereas the median LND was 11.1%. At 5, 8, and 10 years, CSS rates were 92.5%, 83.9%, and 82.8%, respectively. At multivariable analyses, number of positive lymph nodes and LND, considered as continuous variables, were independent predictors of CSS (all P≤0.01). A 30% LND cutoff was found to be highly predictive of CSS (P = 0.004), and a cutoff of 2 positive nodes was confirmed to be a strong predictor of CSS (P = 0.02). The number of positive nodes and LND similarly, continuous or dichotomized, increased the accuracy for CSS predictions (0.68–0.69 vs. 0.61 of baseline model). LND cutoff of 30% increased the discrimination the most (0.69; +0.083).ConclusionsThe number of positive lymph nodes and LND showed comparable discriminative power for long-term CSS predictions. A cutoff of 30% LND might be suggested for the selection of patients candidate for adjuvant systemic therapy, because it increased the model's discrimination the most.     

Pattern of care in locally advanced breast cancer: Focus on local therapy

Background and MethodsThe optimal treatment of locally advanced breast cancer (LABC) remains undetermined. We analyzed factors influencing local therapy in LABC in a pooled material including three large clinical series.ResultsOf a total of 787 patients, local therapy was given in 604, surgery in 184, radiotherapy in 69, and a combination thereof in 351. The use of local therapy was related to younger age, lower clinical T and N stage, no skin involvement and no progression during induction chemotherapy. The use of surgery was related to younger age, lower clinical T and N stage, no clinical skin involvement and response to induction chemotherapy. The use of postoperative radiotherapy was correlated with larger tumor size, higher number of positive lymph nodes, positive surgical margin, extracapsular lymph node extension, lymphatic vessel invasion and skin involvement.ConclusionsThe most frequent local therapy in LABC remains a combination of surgery and radiotherapy. Clinical and pathological characteristics influence the type of local treatment.     

Seroma indicates increased risk of lymphedema following breast cancer treatment: A retrospective cohort study

IntroductionLymphedema is one of the most serious complications following breast cancer treatment. While many risk factors are well described the role of seroma formation has recently produced mixed results. Therefore, we aimed to evaluate if seroma is a risk factor for development of lymphedema in one of the largest retrospective cohort studies.Material and methodsWe included all patients with unilateral breast cancer treated in the period of 2008-2014. Data regarding treatment and breast cancer characteristics were retrieved from the national breast cancer registry. Data regarding lymphedema treatment and seroma aspirations were retrieved from local treatment codes.ResultsIn total 1822 patients were included of which 291 developed lymphedema. Multivariate cox regression analysis showed that seroma was an independent risk factor (HR 1.92 CI 1.30-2.85, p= 0.001). Other independent risk factors were lymphadenectomy, radiation therapy, chemotherapy, BMI above 30, total lymph nodes removed above 15 and higher number of metastatic lymph nodes.ConclusionsPostoperative seroma doubles the risk of developing lymphedema. Future studies should examine if seroma reducing measures will lead to lower risk of lymphedema.     

Monopolar radiofrequency skin tightening

The development of nonablative monopolar capacitive radiofrequency technology (ThermaCool System, Thermage, Inc., Hayward, California) has contributed to the noninvasive trend in facial skin rejuvenation. In contrast to traditional ablative resurfacing techniques, the ThermaCool System protects the skin surface from injury while selectively heating the underlying dermis. Preservation of epidermal integrity minimizes recovery and the risk of complications. Published clinical evidence documents the efficacy of monopolar capacitive radiofrequency skin tightening and supports its use for mild to moderate facial skin laxity and rhytides. Currently, monopolar capacitive radiofrequency represents the gold standard of treatments designed to tighten skin in a noninvasive fashion.     

A New Agent,Blue and Radioactive,for Sentinel Node Detection

Background: Although with some disadvantages, combining radiotracer and isosulfan blue facilitates the detection of sentinel lymph nodes. This study was designed to evaluate the use of ^99mTc-labeled phthalocyanine tetrasulfonate (^99mTc-PCTS) as a single agent for simultaneous blue staining and radiotracer localization of the sentinel lymph node.Methods: Twelve rabbits were injected into the dermis and subcutaneously in the distal hind limb with 1 mL of blue ^99mTc-PCTS (.5 mCi). The popliteal and inguinal fossae were explored between 15 minutes and 24 hours after injection for blue and/or radioactive tissue. Popliteal and inguinal fossae and other lymph nodes and organs were harvested for determination of the concentration of radioactivity and for histology.Results: Within minutes of ^99mTc-PCTS injection, the lymphatic channels were easily identified by the blue color. At 10 minutes, the radioactive count over the popliteal fossa was significantly higher than over other areas. At exploration, a blue and radioactive popliteal node was identified in all animals; inguinal nodes were neither blue nor radioactive. At death, the radioactivity in the popliteal node was 1000 times higher than in other nodes or organs. Although fainter, the blue color in the popliteal node was still visible at 6 weeks. Histological sections of popliteal node identified the dye in the cytoplasmic compartment of the cells.Conclusions: Technetium-99m PCTS is a single agent that identifies sentinel lymph nodes by color and radioactivity and is retained for an extended period of time without migrating to other tissues.     

Distal Gastric Cancer and Extensive Surgery: A New Evaluation Method Based on the Study of the Status of Residual Lymph Nodes After Limited Surgery

Background: Curative resection (R0) is the treatment of choice for distal gastric cancer, but it is unclear whether this operation should include a total gastrectomy (TG) with splenectomy and extended (D2) lymph node dissection. A new concept was developed based on the fact that residual metastatic lymph nodes after a limited (D1) subtotal gastrectomy (SG) may be the source of fatal relapse. We conducted a prospective study on patients who had undergone a D2 TG to evaluate whether certain stations left behind after a D1 SG contain metastasis.Methods: We studied 1207 nodes obtained from 35 eligible patients who underwent a TG within 2 years. Of these patients, 29 fulfilled the criterion for a D2 dissection with curative potential. Numbers of retrieved and tumor-containing nodes by each station according to the Japanese Research Society for Gastric Cancer were documented prospectively in a standardized protocol. All lymph nodes were studied in sections smaller than 2 mm, but emphasis was given to the study of nodes from stations 1 and 2 (paracardial right and left), station 10 (splenic hilum), and stations 7 through 12 (around celiac axis, and in hepatoduodenal ligament) that can be dissected with a TG, splenectomy, and D2 dissection, respectively. For quality control of D2 dissection, the numbers ofnodes retrieved by each compartment II nodal station (7–12) documented by a pathologist were used and compared with proposed reference values. Long-term survival and cumulative risk of relapse were calculated in terms of lymph node status and presence of metastasis in compartment II nodes.Results: A mean total node yield of 37.4 from stations 1–12 and 11.4 from compartment II (stations 7–12) was obtained from 29 patients who had a D2 TG with curative intent. A substantial variation in node yields was found, and sometimes several stations contained no lymph nodes, which suggested an important cause of noncompliance (no yield of lymph nodes detected by the pathologist from that indicated for dissection stations) and difficulties for quality control. No positive node was detected in stations 1, 2, and 10 among patients who had a curative TG with splenectomy. However, substantially high was the incidence of metastasis in compartment II nodes, which was detected in one third of patients with node-positive disease. After 10 years of follow-up, overall survival and relapse rates among R0 D2 patients with negative compartment II nodes (pN0/pN1 disease) were 47% and 44%, respectively.Conclusions: Our results suggest the necessity of D2 dissection, but not of TG with splenectomy, to achieve an R0 resection for patients with distal gastric carcinoma. A large prospective study based on our protocol and findings may clarify whether a D2 R0 resection would result in a survival benefit.     

Apocrine sweat gland adenocarcinoma: A rare case report and review

IntroductionPrimary apocrine sweat gland carcinoma (PASGC) is an extremely rare neoplasia whose management and treatment are still evolving. The only curative therapy is wide local excision. Many patients have metastasis at the time of the diagnosis, mainly because this neoplasm has been misdiagnosed as some benign skin lesions.Presentation of caseWe herein report a case of a 72-year-old-man with PASGC affecting the axilla and regional lymph nodes that underwent surgical resection and lymphadenectomy at our Institution. This is the first case reported in Brazil.DiscussionOur observation suggests just a MRI as necessary to study tumoral limits and lymph nodes and a full surgical excision with free margins is decisive for success.ConclusionDespite the PASGC be a rare cancer and require expensive tests, knowledge of this disease is critical to reduce costs in medical services without availability of investment.     

The antitumor activity and immunosuppressive effects of 5-fluorouracil suppositories in rectal cancer patients

The antitumor activity and immunological effects of the local administration of 5FU were investigated by determining the tissue concentration of 5FU, histological appearance of the primary tumor, and lymphocyte subsets of the regional lymph nodes in 23 rectal cancer patients. Twelve patients were treated with 5FU suppositories preoperatively, being the 5FU group, while 11 patients were given no preoperative treatment, being the control group. The 5FU concentrations in the primary tumors were higher than those in the regional lymph nodes and appeared to remain high for an extended period. No histological changes peculiar to the 5FU group were observed in the primary tumors. An analysis of the lymphocyte subsets in the pararectal nodes revealed that Leu2a⁺15^– cells, or cytotoxic T lymphocytes, were significantly decreased in numbers in the 5FU group compared to the control group. These results suggest that the local use of 5FU may not only exert an antitumor effect against rectal cancer, but can also cause the suppression of antitumor immunity in the regional lymph nodes.     

穴位埋线联合单极射频在面部抗衰老治疗中的应用效果

目的 探究穴位埋线联合单极射频在面部抗衰老治疗中的效果。 方法 选取我院2021年1月-2022年 1月收治的70例面部衰老患者,采用随机数字表法分为常规组（n=34,穴位埋线）及治疗组（n=36,穴位 埋线联合单极射频）,比较两组面部改善情况、患者满意度及不良反应发生率。 结果 治疗组治疗后皮肤 紧致度、鼻唇沟、木偶纹、皱纹改善情况均优于常规组,差异有统计学意义（P＜0.05）;治疗组患者满意 度为94.44%,高于常规组的73.52%,差异有统计学意义（P＜0.05）;两组不良反应发生率比较,差异无统 计学意义（P＞0.05）。 结论 穴位埋线联合单极射频可有效改善面部老化状态,治疗后患者的皮肤紧致程 度、皱纹等均得到改善,患者满意度较高,且不增加不良反应发生率。     

The prognosis and the impact of radiotherapy in clinically regional lymph node-positive prostate cancer: Which patients are candidates for local therapy with radiation?

BackgroundThis study aimed to identify the prognostic and predictive factors of local radiotherapy in clinically regional lymph node-positive prostate cancer.Patients and MethodsThis study includes patients who were newly diagnosed with regional lymph node-positive prostate cancer between 2008 and 2017. We investigated the prognostic value of clinicopathological parameters for progression-free survival (PFS) and overall survival (OS) as well as the differential prognostic impact of radiotherapy by subgroup analysis.ResultsAmong the 93 men enrolled as patients, 48 (51.6 %) were treated with radiotherapy. The biopsy positive core rate and biopsy Gleason score were associated with PFS, and the number of lymph node metastases was associated with both PFS and OS. Patients who underwent radiotherapy showed better PFS and OS. High-risk features (at least 2 criteria among ≥75% biopsy positive core rate, Gleason score ≥9, and ≥2 positive lymph nodes) were especially associated with improved outcomes after undergoing radiotherapy.ConclusionWe identified prognostic factors for clinically regional lymph node-positive prostate cancer and showed the benefits of local radiation therapy. Patients with high-risk features may be especially suitable candidates for radiotherapy.     

Demonstration of second-tier lymph nodes during preoperative lymphoscintigraphy for melanoma: Incidence varies with primary tumor site

Background: Preoperative cutaneous lymphoscintigraphy (LS) to identify sentinel (first-tier) lymph nodes was performed in 250 consecutive melanoma patients before wide local excision only or wide local excision with sentinel node biopsy. Methods: The location of the sentinel nodes was marked on the overlying skin in all patients. Whether or not tracer was present in second-tier lymph nodes on the delayed scans was recorded for each patient and related to the lesion site at which the tracer had initially been injected. For 100 consecutive patients the rate of tracer movement through the lymphatic channels was compared to the incidence of second-tier drainage. Results: Second-tier nodes were visualized in all patients with melanomas on the leg and thigh, and in almost all patients with melanomas on the forearm and hand, but were seen less often in patients with more centrally located melanomas. There was a significant correlation between the rate of lymph flow and the incidence of demonstrable second-tier drainage. Conclusion: The results suggest that the physiology of the lymphatic system varies depending on the origin of the lymphatic vessel. These findings have important implications for application of the sentinel node biopsy technique in individual patients.