[Is there a rationale for regional node irradiation in pN1mi and pN0(i+) breast tumours?]

The advent of sentinel lymph node technique has led to a shift in lymph node staging, due to the emergence of new entities, namely micrometastases and isolated tumour cells. In addition, the therapeutic role of axillary lymph node dissection is more and more questioned and radiotherapy has been shown to be equivalent to complementary axillary lymph node dissection in patients without clinical node involvement. This article looks at the literature in favour of performing axillary irradiation in patients with pN1mi stage breast cancer who have undergone a mastectomy without a complementary axillary lymph node dissection, and in favour of abstention of any further treatment of the axilla in patients with pN0(i+) or pN1mi tumours who have undergone breast conserving surgery and a sentinel lymph node procedure followed by systemic treatment. The impact of regional lymph nodes irradiation in case of axillary involvement 2mm or less is also discussed.

[Lymph nodes of esophagus cancer: radiological approach]

The cervico-thoracic-abdominal-pelvic CT-scan is a key examination of the staging of esophagus cancers. Anatomical and pathophysiological knowledge of the lymph nodes is an essential tool to establish a precise mapping. Imaging tests (such endoscopic ultrasound and PET scanning) will be very useful to determine clinical options and clinical target volume delineation for the radiotherapy of esophagus cancers.

[Guidelines for the delineation of the lymph nodes areas in gynecological malignancies]

Gynecological cancers are lymphophilic cancers, which require the systematic inclusion of nodal areas in the clinical target volume when irradiation is planned in the therapeutic strategy for these cancers. Radiotherapy with intensity modulation that achieves better saving of healthy tissue is more often used. However, the very steep dose gradients generated by this technique can lead to poorer coverage of target volumes if they are not defined very precisely by taking into account their anatomical location. This is particularly true for lymph node target volumes, so the purpose of this article is to present recommendations from a literature review focused on this issue, in terms of selection and delineation of lymph node in irradiation of cervix and endometrial cancers.