Optimal treatment strategies for clinically suspicious lateral pelvic lymph node metastasis in rectal cancer

Abstract

BackgroundAlthough lateral pelvic lymph node (LPN) metastasis is a major cause of local recurrence in patients with rectal cancer, controversy still remains on the treatment of suspected LPN metastasis, “suspicious LPN”. We aimed to determine the optimal treatment strategies for suspicious LPN, in patients with locally advanced rectal cancer who underwent preoperative chemoradiotherapy (CRT).Materials and MethodsOf 377 patients who received preoperative CRT for rectal cancer between 2006 and 2013, 84 (22.3%) had suspicious LPNs on pretreatment MRI. Patients’ characteristics, MRI findings, operative and pathologic findings, and oncologic outcomes were analyzed retrospectively.ResultsOf 84 patients with suspicious LPNs, 61 showed good response to CRT on posttreatment MRI (short-axis LPN diameter < 5 mm). Among them, 31 patients underwent TME alone (group A), and 30 underwent TME plus LPND (group B). The remaining 23 patients had persistently suspicious LPNs on post-CRT MRI and underwent TME plus LPND (group C). Pathologic LPN metastasis was confirmed in five patients (16.7%) in group B and 15 (62.5%) in group C. Local recurrence developed in 7 (22.6%), 0 (0%), and 4 (17.4%) patients in groups A, B, and C, respectively. Five patients (16.1%) in group A developed in situ LPN recurrences. The 3-year disease-free survival rates were 53.7%, 74.2%, and 46.9% in groups A, B, and C, respectively.ConclusionsStudy findings suggested that LPND cannot be omitted for patients with suspicious LPNs on pretreatment MRI even with good response to CRT. Findings from pretreatment MRI should be considered to determine whether LPND is indicated.

Lateral Pelvic Lymph Node Metastases in Rectal Cancer: A Systematic Review

“…In the other nine studies, pathologically confirmed LPLN occurred in a range from 25.0 to 61.1% of all patients had after uni-or bilateral LPLD. Only five [22,23,26,27,29] and seven studies [22][23][24][25][26][27]29]…”

Regulation of radiosensitivity by 4‑methylumbelliferone via the suppression of interleukin‑1 in fibrosarcoma cells

“…Combining chemotherapy (e.g. cisplatin, 5-fluorouracil, and paclitaxel) with targeted inhibitors can potentially overcome radioresistance and extend progression-free and overall survival (7)(8)(9)(10)(11)(12). However, few studies have examined the efficacy of combined treatments in preventing distant metastasis (10).…”

Clinical Implications of Lymph Node Metastasis in Colorectal Cancer: Current Status and Future Perspectives

“…However, preoperative CRT may sterilize lymph nodes in the pelvic sidewall. Therefore, the indication criteria for LPND, especially size criteria (≥5 mm, ≥7 mm, or ≥10 mm) and the timing of imaging studies (preoperative or postoperative) are still controversial [57][58][59][60].…”