From the Guidelines
Treatment of level three lymph nodes is crucial and should be based on a thorough diagnosis, including a surgical specimen or excisional lymph node biopsy, and pathological review by an expert hematopathologist 1. When it comes to follicular lymphoma, the approach to treating level three lymph nodes depends on the grade of the disease.
- For grades 1,2, and 3A, which are considered indolent, treatment should be tailored to the specific needs of the patient, taking into account the extent of disease and the patient's overall health status 1.
- For grade 3B, which is treated as an aggressive lymphoma, a more intensive approach may be necessary, including combination chemotherapy and possibly radiation therapy 1. It's essential to note that the treatment plan should be individualized and discussed by a multidisciplinary team, including hematologists, oncologists, and other relevant specialists, to ensure the best possible outcomes in terms of morbidity, mortality, and quality of life. In the context of level three lymph node involvement, a thorough staging workup is necessary to determine the extent of disease and guide treatment decisions, as outlined in the ESMO clinical practice guidelines for diagnosis, treatment, and follow-up of newly diagnosed and relapsed follicular lymphoma 1.
From the Research
Level Three Lymph Node Treatment
The treatment for level three lymph nodes depends on various factors, including the type and stage of cancer.
- The study 2 suggests that sequential adjuvant therapy with doxorubicin/paclitaxel/cyclophosphamide may be effective for resectable breast cancer involving four or more axillary nodes.
- Another study 3 found that doxorubicin-based chemotherapy and radiotherapy can be effective for adult patients with early stage primary systemic anaplastic large-cell lymphoma.
- The study 4 compared the effectiveness of cyclophosphamide, methotrexate, and fluorouracil (CMF) with and without doxorubicin in the adjuvant treatment of resectable breast cancer with one to three positive axillary nodes, and found no significant difference between the two treatment groups.
- A randomized controlled trial 5 compared adjuvant doxorubicin and cyclophosphamide (AC) with cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) in premenopausal women with axillary lymph node positive breast carcinoma, and found no difference between the two treatment groups in terms of disease-free and overall survival rates.
- A recent study 6 found that combination therapy of doxorubicin and cyclophosphamide followed by docetaxel combined with methionine restriction led to a complete response in a patient with invasive lobular breast cancer and axillary lymph node metastases.
Treatment Options
Some possible treatment options for level three lymph nodes include:
- Chemotherapy: doxorubicin, cyclophosphamide, paclitaxel, and other agents may be used alone or in combination.
- Radiotherapy: may be used in combination with chemotherapy or as a standalone treatment.
- Methionine restriction: may be used in combination with chemotherapy to target methionine-addicted cancer cells.
- Surgery: may be necessary to remove affected lymph nodes or tumors.