Inguinal Lymph Node Recurrence in the Untreated Groin of Patients with Anal Carcinoma

Blinde, Sanne E.; Schasfoort, Renske; Mens, Jan Willem M.; Verhoef, Cornelis; Olofsen, M.; Nuyttens, J.

doi:10.1097/dcr.0000000000000050

Cited by 17 publications

(9 citation statements)

References 26 publications

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“…These studies showed that inguinal node radiation achieved excellent nodal control, and the inguinal node should be involved in the radiation field. Blinde et al found that the 5-year inguinal recurrence rate was high in patients who did not receive elective irradiation therapy to the groin and suggested that elective irradiation of the groin should be considered for local control 31. The results of the Trans-Tasman Radiation Oncology Group study (TROG) 99.02 also showed that T1-2 anal carcinomas require elective inguinal radiation treatment 32.…”

Section: Discussionmentioning

confidence: 99%

Anal adenocarcinoma requires prophylactic inguinal nodal treatment: Results from a single Chinese institution

Guo

Mao

et al. 2017

J. Cancer

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Background: Literature pertaining to prophylactic inguinal nodal treatment for anal adenocarcinoma in China is scarce.Methods: In this retrospective study, we analyzed 126 patients from 1965 to 2015. Among these, 67 patients received surgery only, 18 patients received chemoradiotherapy only, 27 patients received a combination of both, and the remaining 14 patients received palliative treatment.Results: The median follow up period was 30 months. The 1-year, 3-year, and 5-year overall survival rates were 85.8%, 62.5%, and 43.4%, respectively. The 5-year overall survival was 46.9% for patients with negative inguinal lymph nodes and 19.1% for patients with positive inguinal lymph nodes (p=0.007). The overall 5-year inguinal node relapse-free survival was 83.0%. The 5-year inguinal node relapse-free survival was 87.5% for stage I, 86.9% for stage II, and 76.5% for stage III cancers. Among those with negative inguinal nodes, the 5-year inguinal node relapse-free survival was 85.7% for negative regional lymph nodes and 75.4% for positive regional lymph nodes (p=0.089).Conclusion: Inguinal lymph node is a high-risk subclinical area. Prophylactic inguinal nodal treatment is necessary for patients with anal adenocarcinoma irrespective of positive or negative inguinal lymph nodes.

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Section: Discussionmentioning

confidence: 99%

Anal adenocarcinoma requires prophylactic inguinal nodal treatment: Results from a single Chinese institution

Guo

Mao

et al. 2017

J. Cancer

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“…Several studies have shown the importance of elective groin irradiation especially for T3-T4 tumors. Among patients with uninvolved inguinal nodes at diagnosis who did not receive elective radiation to the groin the inguinal recurrence rates for T1-2N0 tumors range from 5% to 13%, while for T3-4N0 tumors it is 6-30% [9][10][11][12][13]. Matthews et al prematurely closed a study (T1-2N0, no radiation to the groins) because of an unacceptable high inguinal relapse of 22.5% after three years [14].…”

Section: Introductionmentioning

confidence: 99%

Dosimetric quantification of the incidental irradiation of the ‘true’ (deep) ano-inguinal lymphatic drainage of anal cancer patients not described in conventional contouring guidelines

et al. 2018

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“…The indication of prophylactic inguinal irradiation is, however, controversial. According to the two largest retrospective studies 4,5 it is clear that treating or not the inguinal LNs based only on the T stage has a large risk of over/under-treatment. A better detection of early inguinal LNs involvement could properly select patients who really deserve inguinal irradiation.…”

Section: Discussionmentioning

confidence: 99%

“…In a retrospective analysis of 270 patients who did not receive prophylactic inguinal irradiation, after a median follow-up of 72 months, the incidence of inguinal metastases was 8% 3 . Two retrospective studies reported the inguinal recurrence rate in patients staged with conventional examinations who did not receive prophylactic inguinal irradiation: Blinde et al 4 showed inguinal recurrence rate of 0% in T1, 10% in T2 and 20% in T3–T4 patients with a median follow-up of 65 months, and Ortholan et al 5 reported an inguinal recurrence rate of 12% for T1–T2, and 30% for T3–T4 patients with a median follow-up of 61 months. As a consequence, the prescription of prophylactic inguinal irradiation based only on the T stage would cause an unnecessary irradiation of about 70–80% of T3–T4 patients, submitting them to a risk of severe acute toxicity, especially when using conformal RT techniques 6 .…”

Section: Introductionmentioning

confidence: 99%

Impact of sentinel lymph-node biopsy and FDG-PET in staging and radiation treatment of anal cancer patients

Slim

Passoni

Incerti

et al. 2020

Sci Rep

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to assess the role of sentinel lymph-node biopsy (SLnB) and fDG-pet in staging and radiation treatment (RT) of anal cancer patients. This retrospective study was performed on 80 patients (male: 32, female: 48) with a median age of 60 years (39-89 years) with anal squamous cell carcinoma who were treated from March 2008 to March 2018 at the IRCCS San Raffaele Hospital. Patients without clinical evidence of inguinal Lns metastases and/or with discordance between clinical evidence and imaging features were considered for SLNB. FDG-PET was performed in 69/80 patients. Patients with negative imaging in inguinal region and negative SLnB could avoid Rt on groin to spare inguinal toxicity. CTV included GTV (primary tumour and positive LNs) and pelvic ± inguinal LNs. PTV1 and PTV2 corresponded to GTV and CTV, respectively, adding 0.5 cm. RT dose was 50.4 Gy/28 fractions to PTV2 and 64.8 Gy/36 fractions to PTV1, delivered with 3DCRT (n = 24) or IMRT (n = 56), concomitant to Mitomycin-C and 5-FU chemotherapy. FDG-PET showed inguinal uptake in 21/69 patients (30%) and was negative in 48/69 patients (70%). Lymphoscintigraphy was performed in 11/21 positive patients (4 patients SLNB confirmed inguinal metastases, 6 patients false positive and 1 patient SLN not found), and in 29/48 negative patients (5/29 showed metastases, 23/29 true negative and 1 SLN not found). Sensitivity, specificity, positive and negative predictive value of FDG-PET were 62%, 79%, 40% and 82%, respectively. Median follow-up time from diagnosis was 40.3 months (range: 4.6-136.4 months): 69 patients (86%) showed a complete response, 10 patients (13%) a partial response, 1 patient (1%) a stable disease. Patients treated on groin (n = 54) versus not treated (n = 26) showed more inguinal dermatitis (G1-G2: 50% vs. 12%; G3-G4: 17% vs. 0%, p < 0.05). For patients treated on groin, G3-G4 inguinal dermatitis, stomatitis and neutropenia were significantly reduced with IMRT against 3DCRT techniques (13% vs. 36%, p = 0.10; 3% vs. 36%, p = 0.003; 8% vs. 29%, p = 0.02, respectively). SLNB improves the fDG-pet inguinal Lns staging in guiding the decision to treat inguinal nodes. iMRt technique significantly reduced G3-G4 toxicities when patients are treated on groin. Squamous cell carcinoma (SCC) of the anal canal is a relatively uncommon tumour constituting only 4% of all lower alimentary tract and 2% of all digestive system malignancies. The tumour size (T stage) and the nodal status are recognized as the main prognostic factors 1. Chemo-radiotherapy (CRT) is the standard treatment for anal SCC; whereas mesorectal and internal iliac lymph nodes (LNs) are routinely included in the radiation fields, the need of prophylactic inguinal irradiation is controversial.

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Inguinal Lymph Node Recurrence in the Untreated Groin of Patients with Anal Carcinoma

Abstract: Elective irradiation of the groin should be considered for local control in patients (N0-N1) with T2 tumors ≥4 cm in size and/or located in the perianal skin, and in all patients with T3 and T4 tumors.

Cited by 17 publications

References 26 publications

Anal adenocarcinoma requires prophylactic inguinal nodal treatment: Results from a single Chinese institution

Anal adenocarcinoma requires prophylactic inguinal nodal treatment: Results from a single Chinese institution

Dosimetric quantification of the incidental irradiation of the ‘true’ (deep) ano-inguinal lymphatic drainage of anal cancer patients not described in conventional contouring guidelines

Impact of sentinel lymph-node biopsy and FDG-PET in staging and radiation treatment of anal cancer patients

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