Vol 27, No 1 (2022)
Review paper
Published online: 2022-01-24

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Stereotactic radiotherapy for oligometastases in the lymph nodes

Francesco Pasqualetti1, Fabio Trippa2, Cynthia Aristei3, Simona Borghesi4, Caterina Colosimo5, Martina Cantarella6, Rosario Mazzola7, Gianluca Ingrosso8
Rep Pract Oncol Radiother 2022;27(1):46-51.

Abstract

Even though systemic therapy is standard treatment for lymph node metastases, metastasis-directed stereotactic radiotherapy (SRT) seems to be a valid option in oligometastatic patients with a low disease burden.

Positron emission tomography/computed tomography (PET-CT) is the gold standard for assessing metastases to the lymph nodes; co-registration of PET-CT images and planning CT images are the basis for gross tumor volume (GTV) delineation. Appropriate techniques are needed to overcome target motion. SRT schedules depend on the irradiation site, target volume and dose constraints to the organs at risk (OARs) of toxicity. Although several fractionation schemes were reported, total doses of 48–60 Gy in 4–8 fractions were proposed for mediastinal lymph node SRT, with the spinal cord, esophagus, heart and proximal bronchial tree being the dose limiting OARs. Total doses ranged from 30 to 45 Gy, with daily fractions of 7–12 Gy for abdominal lymph nodes, with dose limiting OARs being the liver, kidneys, bowel and bladder. SRT on lymph node metastases is safe; late side effects, particularly severe, are rare.

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