Carbon‐ion radiotherapy for isolated para‐aortic lymph node recurrence from colorectal cancer

Isozaki, Yuka; Yamada, Shigeru; Kawashiro, Shohei; Yasuda, Shigeo; Okada, Naohisa; Ebner, Daniel K.; Tsuji, Hiroshi; Kamada, Tadashi; Matsubara, Hisahiro

doi:10.1002/jso.24757

Cited by 17 publications

(14 citation statements)

References 22 publications

(54 reference statements)

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“…A median total dose was 52.8 Gy (RBE) (range, 48.0–52.8 Gy [RBE]) in 12 fractions for 3 weeks with a dose fraction of 4.0–4.4 Gy (RBE). The safety and efficacy of the dose fraction regimen has been shown in the previous studies for para-aortic lymph node metastasis from colorectal cancer and for postoperative lymph node metastasis of esophageal cancer (9, 10). Median interval time between the first and second treatments was 16 months (range, 6–72 months).…”

Section: Methodsmentioning

confidence: 83%

Carbon-ion Radiotherapy for Isolated Lymph Node Metastasis After Surgery or Radiotherapy for Lung Cancer

et al. 2019

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Purpose: Mediastinal and hilar lymph node metastasis is one of the recurrence patterns after definitive treatment of lung cancer. Salvage radiotherapy (RT) can be a treatment option for lymph node metastasis. However, the usefulness of additional RT remains unclear after surgery or RT for the primary lung tumor. We retrospectively evaluated the efficacy and safety of hypofractionated carbon-ion RT for isolated lymph node metastasis. Methods and Materials: Between April 2013 and August 2016, 15 consecutive patients with isolated lymph node metastasis underwent carbon-ion RT. The pretreatment evaluations confirmed the isolated lymph node metastasis and the absence of local recurrence or distant metastasis, which was oligometastatic disease. The median age was 72 (range, 51–83) years, with 11 male patients. The first treatments for primary lung tumors were carbon-ion RT for 8 patients and surgery for 7 patients. There were 9 adenocarcinomas, 4 squamous cell carcinomas, 1 adenosquamous cell carcinoma, and 1 mucoepidermoid carcinoma. Most patients (93%) were irradiated with 52.8 Gy relative biological effectiveness in 12 fractions for 3 weeks. There were no patients treated with concurrent or adjuvant therapy such as chemotherapy, molecular-targeted therapy, or immunotherapy. Adverse events were evaluated according to the Common Terminology Criteria for Adverse Events (version 4.0). Results: The median follow-up for surviving patients was 28 months. One patient experienced local lymph node recurrence, and the 2-year local control rate was 92% for all patients. Distant metastasis was observed in 7 patients, and 2-year progression-free survival rate was 47%. During follow-up, there were 4 deaths from lung cancer, and the 2-year overall survival rate was 75%. There were 2 patients with acute grade 2 esophagitis and 2 with late grade 2 cough, which were improved by conservative therapy. There were no other grade 2 or higher adverse events. Conclusions: Hypofractionated carbon-ion RT showed excellent local control and overall survival without severe toxicities in lung cancer patients with isolated lymph node metastasis after surgery or carbon-ion RT for primary lung tumors. A multi-institutional prospective study is required to establish the efficacy and safety of carbon-ion RT.

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Section: Methodsmentioning

confidence: 83%

Carbon-ion Radiotherapy for Isolated Lymph Node Metastasis After Surgery or Radiotherapy for Lung Cancer

et al. 2019

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“…The overall survival rates at 2 and 3 years were 83.3% and 63.0%, respectively. 22 In the Korean study, where patients were treated with three-dimensional conformal radiotherapy or helical tomotherapy plus capecitabine or 5-fluorouracil, it was reported that the 3-and 5-year overall survival rates were 64.7% and 36.4%, median overall survival was 41 months and median recurrence-free survival was 20 months. In our study, we used the IMRT or VMAT to further explore the safety and efficacy of radiotherapy combined with systemic therapy.…”

Section: Discussionmentioning

confidence: 99%

<p>The Role of Radiotherapy in the Treatment of Retroperitoneal Lymph Node Metastases from Colorectal Cancer</p>

Shu

Ouyang

Wang

et al. 2020

CMAR

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Purpose: Retroperitoneal lymph node metastases are rare in colorectal cancer. Optimal treatment strategies are still unknown. Patients and Methods: We retrospectively enrolled colorectal cancer patients who had received radiotherapy for retroperitoneal lymph node metastases from 2009 to 2018. Patients with isolated retroperitoneal lymph node metastases or retroperitoneal lymph nodes with extra-retroperitoneal metastases were all included. A median dose of 60 Gy was delivered. Results: A total of 68 patients were enrolled in this study; 28 (41%) of them had extraretroperitoneal metastases. In the isolated retroperitoneal lymph node metastases group, complete response was found in 5 patients (12.5%), partial response was achieved in 20 patients (50%), 9 patients (22.5%) had stable disease. The 1-, 2-and 3-year local control rates were 87.5%, 77.5%, and 70%. In the extra-retroperitoneal metastases group, the disease control rate was 75%, including complete response in 1 patient (3.6%), partial response in 4 patients (14.3%) and stable disease in 16 patients (57.1%). The 1-, 2-and 3-year local control rates were 57.1%, 42.8%, and 0%. The median overall survival was 59.4 months and 19 months in the isolated retroperitoneal lymph node metastases group and extra-retroperitoneal metastases group, respectively. In the isolated retroperitoneal lymph node metastases group, the 1-year and 3-year overall survival values were 90.2% and 75.8%, respectively. The 1-year and 3-year progression-free survival values were 57.9% and 0%, respectively. The extra-retroperitoneal metastases group experienced worse survival outcome (1-year overall survival: 57.9%, P<0.05; and 1-year progression-free survival: 22.5%, P<0.05). Conclusion: For patients with isolated retroperitoneal lymph node metastases, radiotherapy combined with systemic treatment can be used as a method to achieve no evidence of disease and can result in good local control and survival. For patients with extra-retroperitoneal metastases, although the survival is much worse than that of isolated retroperitoneal lymph node metastases, radiotherapy is an effective palliative treatment to relieve pain and obstruction based on systemic treatment.

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“…The advantages of heavy ion radiotherapy include the drop of radiation dose to almost zero beyond the Bragg peak, and generation of much more DNA double-strand damage in contrast to photon or proton radiation. Carbon ion (heavier than proton and often regarded as heavy ion, sometimes called light ion) beam radiotherapy has been shown to be effective in treating melanoma [ 24 ], lung cancer [ 25 ], liver cancer [ 26 ], colorectal cancer [ 27 ], head and neck cancer [ 28 ], and kidney cancer [ 29 ]. Based on the experience of Yamagata University Hospital, the diseases suitable for heavy ion therapy include the tumors of the head and neck, pulmonary and mediastinal, gastrointestinal tract (esophagus, rectum, recurrent colon inside the pelvis), liver, gallbladder, pancreas, urologic tract (prostate and kidney), breast, and bone and soft tissues, as well as locally advanced gynecologic cancers (locally advanced uterine cervical cancer, locally advanced cervical endometrial cancer, malignant melanoma of the gynecologic area) and metastatic cancers (metastatic lung tumor, metastatic liver cancer, metastatic lymph nodes) [ 30 ].…”

Section: Question 73: Is There Any Diversity Among Different Types Ofmentioning

confidence: 99%

The 150 most important questions in cancer research and clinical oncology series: questions 67–75

Cancer

2017

Chin J Cancer

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Since the beginning of 2017, Chinese Journal of Cancer has published a series of important questions in cancer research and clinical oncology, which sparkle diverse thoughts, interesting communications, and potential collaborations among researchers all over the world. In this article, 9 more questions are presented as followed. Question 67. How could we overcome the resistance of hepatocellular carcinoma against chemotherapeutics? Question 68. Is pursuit of non-covalent small-molecule binders of RAS proteins viable as a strategy of cancer drug discovery? Question 69. In what oligomeric structures do RAS proteins signal? Question 70. How can we achieve non-invasive early detection and diagnosis of lung cancer? Question 71. Does genetic information influence the volatolome enabling diagnosis of lung cancer with genetic mutations via cell headspace or breath analysis? Question 72. Is heavy ion beam radiotherapy effective to kill cancer stem cells? Question 73. Is there any diversity among different types of cancer in terms of sensitivity to heavy ion beam radiotherapy? Question 74. Can targeted alpha-particle therapy augment the effect of carbon ion radiotherapy on malignancies? Question 75. How does chromosomal instability drive tumor progression?

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Carbon‐ion radiotherapy for isolated para‐aortic lymph node recurrence from colorectal cancer

Abstract: CIRT for isolated PALN recurrence after curative resection for CRC appears effective and safe, and it is considered a promising therapy.

Cited by 17 publications

References 22 publications

Carbon-ion Radiotherapy for Isolated Lymph Node Metastasis After Surgery or Radiotherapy for Lung Cancer

Carbon-ion Radiotherapy for Isolated Lymph Node Metastasis After Surgery or Radiotherapy for Lung Cancer

<p>The Role of Radiotherapy in the Treatment of Retroperitoneal Lymph Node Metastases from Colorectal Cancer</p>

The 150 most important questions in cancer research and clinical oncology series: questions 67–75

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