Is the omission of the external iliac or upper pelvic lymph nodes from elective irradiation safe in selected anal canal squamous cell cancers?

IF 4.9 1区 医学 Q1 ONCOLOGY
Karol Paciorek, Anna Zawadzka, Lucyna Pietrzak, Bartłomiej Skrzypiec, Wojciech Michalski, Joanna Socha, Krzysztof Bujko
{"title":"Is the omission of the external iliac or upper pelvic lymph nodes from elective irradiation safe in selected anal canal squamous cell cancers?","authors":"Karol Paciorek, Anna Zawadzka, Lucyna Pietrzak, Bartłomiej Skrzypiec, Wojciech Michalski, Joanna Socha, Krzysztof Bujko","doi":"10.1016/j.radonc.2024.110682","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Guidelines recommend elective irradiation of the external iliac and upper pelvic lymph nodes (LNs) regardless of clinical stage, but the supporting evidence for this recommendation is limited.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 68 consecutive patients with squamous cell carcinoma of the anal canal who underwent volumetric modulated arc therapy chemoradiation, excluding external iliac LNs from elective irradiation. In patients with negative bilateral inguinal LNs, both external iliac regions were omitted, while in those with unilateral positive inguinal LNs, only the ipsilateral external iliac region was included and the contralateral side was omitted. For patients with early-stage tumours, the cranial border of elective irradiation was located in the inferior aspect of the sacroiliac joints.</p><p><strong>Results: </strong>The median follow-up was 4.0 years. Six patients (9 %) experienced recurrence of the primary tumour and three (4 %) developed distant metastases. No isolated nodal recurrences were seen in the LNs that were positive at baseline, or in or outside electively irradiated regions. Notably, no recurrences were seen in any of the 124 external iliac regions omitted from elective irradiation across the 68 patients, or in the upper pelvic region among the subgroup of 33 patients where the cranial irradiation border was at the bottom of the sacroiliac joint. Reducing the elective irradiation volume significantly decreased the dose-volume parameters for organs-at-risk.</p><p><strong>Conclusions: </strong>The present findings suggest that omitting the external iliac and upper pelvic LNs from elective irradiation is safe for selected patients and allows dose reduction in organs-at-risk.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"110682"},"PeriodicalIF":4.9000,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Radiotherapy and Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.radonc.2024.110682","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Guidelines recommend elective irradiation of the external iliac and upper pelvic lymph nodes (LNs) regardless of clinical stage, but the supporting evidence for this recommendation is limited.

Methods: We conducted a retrospective analysis of 68 consecutive patients with squamous cell carcinoma of the anal canal who underwent volumetric modulated arc therapy chemoradiation, excluding external iliac LNs from elective irradiation. In patients with negative bilateral inguinal LNs, both external iliac regions were omitted, while in those with unilateral positive inguinal LNs, only the ipsilateral external iliac region was included and the contralateral side was omitted. For patients with early-stage tumours, the cranial border of elective irradiation was located in the inferior aspect of the sacroiliac joints.

Results: The median follow-up was 4.0 years. Six patients (9 %) experienced recurrence of the primary tumour and three (4 %) developed distant metastases. No isolated nodal recurrences were seen in the LNs that were positive at baseline, or in or outside electively irradiated regions. Notably, no recurrences were seen in any of the 124 external iliac regions omitted from elective irradiation across the 68 patients, or in the upper pelvic region among the subgroup of 33 patients where the cranial irradiation border was at the bottom of the sacroiliac joint. Reducing the elective irradiation volume significantly decreased the dose-volume parameters for organs-at-risk.

Conclusions: The present findings suggest that omitting the external iliac and upper pelvic LNs from elective irradiation is safe for selected patients and allows dose reduction in organs-at-risk.

对于选定的肛管鳞状细胞癌,不对髂外淋巴结或盆腔上淋巴结进行选择性照射是否安全?
背景:指南建议,无论临床分期如何,均应选择性照射髂外淋巴结和盆腔上淋巴结(LN),但支持这一建议的证据有限:我们对68例连续接受容积调控弧形疗法化疗的肛管鳞状细胞癌患者进行了回顾性分析,其中不包括选择性照射的髂外淋巴结。在双侧腹股沟淋巴结阴性的患者中,两侧髂外淋巴结均被省略,而在单侧腹股沟淋巴结阳性的患者中,仅同侧髂外淋巴结被包括在内,对侧则被省略。对于早期肿瘤患者,选择性照射的头颅边界位于骶髂关节的下侧:中位随访时间为 4.0 年。6名患者(9%)原发肿瘤复发,3名患者(4%)出现远处转移。在基线阳性的淋巴结中,或在选择性照射区域内外,均未发现孤立的结节复发。值得注意的是,在68名患者中,有124个髂外区域未进行选择性照射,在33名患者中,头颅照射边界位于骶髂关节底部的骨盆上部区域也未见复发。减少选择性照射量可显著降低危险器官的剂量-体积参数:本研究结果表明,选择性照射时不照射髂外静脉结节和骨盆上静脉结节对选定的患者是安全的,并且可以减少风险器官的剂量。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Radiotherapy and Oncology
Radiotherapy and Oncology 医学-核医学
CiteScore
10.30
自引率
10.50%
发文量
2445
审稿时长
45 days
期刊介绍: Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信