Background This study aimed to explore the impact of excluding the external iliac node (EIN) from the clinical target volume (CTV) during preoperative radiotherapy in T4b rectal cancer with anterior structure invasion. Methods We identified 132 patients with T4b rectal cancer involving the anterior structures who received radiotherapy followed by surgery between May 2010 and June 2019. Twenty-nine patients received EIN irradiation (EIN group), and 103 did not (NEIN group). Failure patterns, survival and toxicities were compared between the two groups. Multivariate Cox proportional hazard regression was used to analyse the factors affecting survival. Results A total of 132 patients with a median age of 55 years were included in the analysis, 94.7% patients were diagnosed as cN+. Distant failure occurred first in 24 patients (18.2%), and total distant metastasis were noted in 31 patients (23.5%). 11 patients (8.3%) developed locoregional recurrence, 10 (9.7%) patients were in the NEIN group, and 1 (3.4%) was in the EIN group (P = 0.34). The EIN region failure rate was seen in 1patient (1.0%) in the NEIN group and no patients in the EIN group. The locoregional recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), overall survival (OS) and progression-free survival (PFS) rates were 96.3% vs. 90.5%, 82.1% vs.73.7%, 75.9% vs. 78.0% and 72.4% vs. 68.3% (all P > 0.05) for the EIN group and NEIN group, respectively. For patients with cN+, NEIN irradiation consistently did not decrease the LRFS, DMFS, OS and PFS compare to the EIN group. EIN irradiation failed to be an independent prognostic factor for LRFS, DMFS, OS and PFS. The incidence of grade 3–4 acute toxicity in the lower intestine was significantly higher in the EIN group than in the NEIN group (13.8% vs. 1.9%, P = 0.02). The Dmax (4479cGy vs. 5039cGy), V35 (45.8cc vs. 91.1cc) and V45 (11.4cc vs. 51.0cc) of the small bowel was decreased in the NEIN group compared to the EIN group. Conclusions Exclusion of the EIN from the CTV in T4b rectal cancer with anterior structure invasion could reduce lower intestinal toxicity without compromising oncological outcomes. These results need further evaluation in future studies.
Objectives: The purpose of this study was to evaluate the association between the diameter of the superior rectal vein (dSRV) and prognosis in patients with locally advanced rectal cancer (LARC).Methods and materials: This retrospective study included 420 patients with LARC who received neoadjuvant therapy followed by total mesorectal resection (TME) from December 2014 to July 2017. The dSRV was measured before treatment. The maximal χ2 method was employed to determine the dSRV threshold of 3.6 mm based on the difference in disease-free survival, and then to divide the patients into 2 groups. The propensity score matching method (PSM) was used to balance the individual characteristics between the two groups. Kaplan–Meier curves and adjusted Cox models were used to determine the relationship among the baseline characteristics and overall survival (OS), disease-free survival (DFS), metastasis-free survival (MFS) and local recurrence-free survival (LRFS).Results: During a median follow-up of 45 months, 7 patients had relapse (1.60%), and 71 had distant metastasis (16.90%). Kaplan–Meier survival curves showed that patients with a dSRV > 3.60 mm had better survival (dSRV > 3.60 mm vs. ≤ 3.60 mm: 3-y MFS: 87.70% vs. 68.20%, P < 0.001; 3-y DFS: 85.50% vs. 64.20%, p < 0.001; 3-y OS: 91.90% vs. 82.20%, p=0.005). The multivariate Cox regression analysis after adjusting the covariates and the multivariate Cox regression analysis after performing PSM showed that the dSRV was an independent prognostic factor for MFS, DFS and OS.Conclusion: The dSRV measurement is valuable in predicting the prognosis of patients with LARC, and the prognosis of patients with a smaller dSRV seems to be poor.
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