Mapping of lateral pelvic lymph node recurrences in rectal cancer: a radiation oncologist’s perspective

Choi, Seo Hee; Chang, Jee Suk; Yoon, Hong In; Jang, Dong Su; Kim, Nam Kyu; Lim, Joon Seok; Min, Byung So; Huh, Hyuk; Shin, Sang Joon; Ahn, Joong Bae; Koom, Woong Sub

doi:10.1007/s00432-018-2624-6

Cited by 7 publications

(6 citation statements)

References 27 publications

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“…Choi et al investigated the recurrence rate of lateral pelvic lymph node among 1243 rectal cancer patients who underwent TME without pelvic radiotherapy. This study revealed that only 2 patients with T3 disease experienced recurrence at the EIN and none of the 18 patients with T4 tumors experienced EIN recurrence [26]. Another study from the MD Anderson Cancer Center also explored the patterns of failure among 45 patients with T4b rectal cancer who received NCRT without EIN irradiation and revealed that no cases suffered EIN metastasis [5].…”

Section: Discussionmentioning

confidence: 97%

Patterns of failure and implications for clinical target volume definition of locally advanced T4b rectal cancer identified with magnetic resonance imaging and treated using neoadjuvant chemoradiotherapy and surgery

Zhang

Song

Geng

et al. 2021

Radiotherapy and Oncology

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Background and purpose: Elective irradiation of the external iliac lymph nodes (EIN) has always been advocated for T4b rectal cancer with anterior organ invasion without convincing evidence. This study aimed to explore the patterns of treatment failure for locally advanced T4b rectal cancer treated using neoadjuvant chemoradiotherapy (NCRT) and surgery. This information may help to clarify whether the current definition of the clinical target volume (CTV) is still appropriate. Materials and methods: We retrospectively analyzed data from 126 patients with locally advanced T4b rectal cancer who received NCRT, without elective EIN irradiation, followed by surgery between January 2010 and October 2018. Pretreatment magnetic resonance imaging was used to identify the T4b disease in all cases. The locoregional recurrence (LRR) rate and EIN failure rate were evaluated, and the LRR locations were identified using a three-dimensional model. Results: After a median follow-up of 53.9 months, LRR occurred in 11.1% of patients (14/126). All LRRs were located in the previously irradiated fields and below the S2-S3 junction. The EIN failure rate was 0.8% (1/126) among all patients and 1.8% (1/56) in the group with anterior genitourinary organ invasion. The estimated 4-year distant relapse-free survival, disease-free survival and overall survival were 79.3%, 73.2% and 86.9%, respectively. Conclusions: It may be feasible to exclude the external iliac region from the CTV during NCRT for locally advanced T4b rectal cancer. However, further studies are needed to clarify whether the cranial border of the CTV can be lowered.

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Section: Discussionmentioning

confidence: 97%

Patterns of failure and implications for clinical target volume definition of locally advanced T4b rectal cancer identified with magnetic resonance imaging and treated using neoadjuvant chemoradiotherapy and surgery

Zhang

Song

Geng

et al. 2021

Radiotherapy and Oncology

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“…Recent studies suggest that lateral pelvic lymph node (LLN) metastasis is a major cause of local recurrence in patients with lower rectal cancer, even when treated with nCRT . In Japan, mesorectal excision (ME) and lateral pelvic lymph node dissection (LLND) surgery without nRT/CRT has been the standard procedure .…”

Section: Surgical Management After Ncrtmentioning

confidence: 78%

Recent advances of neoadjuvant chemoradiotherapy in rectal cancer: Future treatment perspectives

Yamashita

Matsuda

Hasegawa

et al. 2018

Annals of Gastroent Surgery

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Neoadjuvant chemoradiotherapy (nCRT) has been widely used as a multidisciplinary approach for stage II/III rectal cancer. However, its safety and efficacy are controversial because previous studies have shown conflicting outcomes. The present review aimed to elucidate the benefits and limitations of nCRT for patients with rectal cancer. Future perspectives of nCRT are also described. No recent randomized trials have been able to show a survival benefit, although many studies have demonstrated good local control with the use of fluoropyrimidine (e.g. 5‐fluorouracil [FU] or capecitabine)‐based nCRT. Addition of oxaliplatin (OX) to FU‐based nCRT might improve overall survival by preventing distant metastasis, as shown in recent meta‐analyses. However, control of adverse effects is an important concern with this treatment. New treatment strategies such as nonoperative management (watch and wait policy) and total neoadjuvant therapy (TNT) are promising, but the establishment of reliable diagnostic methods of metastasis is essential. Development of new biomarkers is also necessary to select patients who are more likely to benefit from nCRT.

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“…shows the study flow diagram. Fifty-eight cohort studies fulfilled the inclusion criteria of this systematic review [ 6 , 7 , 9 , 11 , 12 , 13 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 …”

Section: Resultsmentioning

confidence: 99%

“…Circumferential Resection Margin (CRM) status is also incredibly important in assessing the risk of LR [ 72 ]. Within this review, the CRM status of the primary tumour was mentioned in 10/58 (17%) studies [ 20 , 21 , 22 , 26 , 32 , 33 , 38 , 40 , 51 , 65 ], however, data were often incomplete or the CRM status attributed to the LRs could not be defined, therefore, these small numbers were not formally assessed. All patients within this review were, however, deemed to have had complete oncological clearance of the primary tumour.…”

Section: Discussionmentioning

confidence: 99%

Locally Recurrent Rectal Cancer According to a Standardized MRI Classification System: A Systematic Review of the Literature

Rokan

Simillis

Kontovounisios

et al. 2022

JCM

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(1) Background: The classification of locally recurrent rectal cancer (LRRC) is not currently standardized. The aim of this review was to evaluate pelvic LRRC according to the Beyond TME (BTME) classification system and to consider commonly associated primary tumour characteristics. (2) Methods: A systematic review of the literature prior to April 2020 was performed through electronic searches of the Science Citation Index Expanded, EMBASE, MEDLINE, and CENTRAL databases. The primary outcome was to assess the location and frequency of previously classified pelvic LRRC and translate this information into the BTME system. Secondary outcomes were assessing primary tumour characteristics. (3) Results: A total of 58 eligible studies classified 4558 sites of LRRC, most commonly found in the central compartment (18%), following anterior resection (44%), in patients with an ‘advanced’ primary tumour (63%) and following neoadjuvant radiotherapy (29%). Most patients also classified had a low rectal primary tumour. The lymph node status of the primary tumour leading to LRRC was comparable, with 52% node positive versus 48% node negative tumours. (4) Conclusions: This review evaluates the largest number of LRRCs to date using a single classification system. It has also highlighted the need for standardized reporting in order to optimise perioperative treatment planning.

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Mapping of lateral pelvic lymph node recurrences in rectal cancer: a radiation oncologist’s perspective

Cited by 7 publications

References 27 publications

Patterns of failure and implications for clinical target volume definition of locally advanced T4b rectal cancer identified with magnetic resonance imaging and treated using neoadjuvant chemoradiotherapy and surgery

Patterns of failure and implications for clinical target volume definition of locally advanced T4b rectal cancer identified with magnetic resonance imaging and treated using neoadjuvant chemoradiotherapy and surgery

Recent advances of neoadjuvant chemoradiotherapy in rectal cancer: Future treatment perspectives

Locally Recurrent Rectal Cancer According to a Standardized MRI Classification System: A Systematic Review of the Literature

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