Cancer spreads locally through direct infiltration into soft tissues, or at a distance by invading vascular structures, then migrating through the lymphatic or blood flow. Although cancer cells carried in the blood can end in virtually any corner of the body, lymphatic migration is usually stepwise, through successive nodal stops, which can temporarily delay further progression. In radiotherapy, irradiation of lymphatic paths relevant to the localization of the primary has been common practice for decades. Similarly, excision of cancer is often completed by lymphatic dissection.
Both in radiotherapy and in surgery, advanced knowledge of the lymphatic pathways relevant to any tumor location is an important information for treatment preparation and execution. The third part of these series describes the lymphatics of the pelvis and the lower limb. It Provides anatomical bases for the radiological delineation of lymph nodes areas in the pelvic cavity and in the groin. It also offers the first original classification for labeling the intrapelvic nodes, grouped in seven paired volumes (called levels I–VII), functionally linked with one another and lower abdominal levels by eight potential drainage pathways.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Radiotherapy and Oncology
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Bony landmarks are not an adequate substitute for lymphangiography in defining pelvic lymph node location for the treatment of cervical cancer with radiotherapy.Int J Radiat Oncol Biol Phys. 1996; 34: 167-172
- Les vaisseaux lymphatiques.in: Traité complet de l’anatomie de l’homme. vol. 4. Delaunay, Paris1836: 147-158 (p. 78–94)
- Lymphangiogram-assisted lymph node target delineation for patients with gynaecological malignancies.Int J Radiat Oncol Biol Phys. 2002; 54: 1147-1152
- Lymphatic spread in cancer of the rectum.Br J Surg. 1935; 23: 395-413
- Selection of lymph node target volumes in head and neck conformal radiotherapy. Proposal for standardizing terminology and procedure based on surgical experience.Radiother Oncol. 2000; 56: 135-150
- The lymphatics in cancer.Saunders, Philadelphia1972
- The lymphatic spread of carcinoma of the cervix and the body of uterus.Am J Obstet Gynecol. 1949; 58: 924-942
- The lymphatic system.in: Grégoire V. Scalliet P. Ang K.K. Clinical target volumes in conformal and intensity modulated radiotherapy. A clinical guide to cancer treatment. Springer Verlag, Berlin, Heidelberg, New York2004: 1-36
- Anatomical bases for the radiological delineation of lymph node areas. Part I: major collecting trunks, head and neck.Radiother Oncol. 2007; 85: 146-155
- Anatomical bases for the radiological delineation of lymph node areas. Part II: upper limbs chest and abdomen.Radiother Oncol. 2007; 84: 335-347
- Interindividual variability of lymph drainages in patients with cervical cancer. Implication on irradiation planning.Strahlenther Onkol. 2006; 182: 80-85
- Cross-sectional nodal atlas: a tool for the definition of clinical target volumes in three-dimensional radiation therapy planning.Radiology. 1999; 211: 815-828
- Lymphatic drainage of superficial tissues of the head and neck: anatomical study and clinical implications.Plast Reconstr Surg. 2008; 121: 1614-1624
- Lymphatic system of the female genitalia. The morphologic basis of oncologic diagnosis and therapy.Saunders, Philadelphia1971
- The lymphatics.Archibald Constable & Co. Ltd., Westminster1903
- Three-dimensional atlas of lymph node topography based on the visible human data set.Anat Rec B New Anat. 2006; 289: 98-111
- Normal lymph node topography. CT atlas of lymphatics.Springer, Berlin, Heidelberg, New York1991
- Definition and delineation of the clinical target volume for rectal cancer.Int J Radiat Oncol Biol Phys. 2006; 65: 1129-1142
- Anatomy of the human lymphatic system. Edward, Ann Arbor1938
Sappey PC. Des vaisseaux lymphatiques. In: Traité d’anatomie descriptive, vol. 2, Delahaye A, Lecrosnier E, editors. Paris; 1888. p. 731–842.
- The lymphatic territories of the upper limb: anatomical study and clinical implications.Plast Reconstr Surg. 2008; 121: 1614-1624
- Mapping pelvic nodes: guidelines for delineation in intensity-modulated radiotherapy.Int J Radiat Oncol Biol Phys. 2005; 63: 1604-1612
Testut L. Des lymphatiques. In: Traité d’anatomie humaine, vol. 2, O Doin, editor. Paris; 1893. p. 267–308.
- Definition and validation of a reference target volume in early stage node-positive cervical carcinoma, based on lyphangiograms and CT-sans.Radiother Oncol. 2000; 54: 163-170
- Topography of the lymph nodes and vessels.in: Gray’s anatomy. 35th ed. Longman, Edinburgh1973: 727-744
- Conformal radiotherapy planning of cervix carcinoma: differences in the delineation of the clinical target volume. A comparison between gynaecologic and radiation oncologists.Radiother Oncol. 2003; 67: 87-95
- Lymphoid system.in: Federative Committee on Anatomical Terminology – terminologica anatomica. Thieme Verlag, Stuttgart1998: 100-103
Published online: December 17, 2008
Accepted: November 4, 2008
Received: September 25, 2008
© 2008 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.