Simultaneous integrated boost intensity-modulated radiation therapy targeting clinically involved extramesorectal lymph nodes in locally advanced rectal cancer: A retrospective study.

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease Pub Date : 2025-01-01 DOI:10.1111/codi.17292

Prashant Nayak, Avanish Saklani, Mufaddal Kazi, Bharath Kumar, Ashwin D'souza, Akshay Baheti, Suman Kumar, Amiya Agrawal, Namrata Pansande, Reena Engineer

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引用次数: 0

Abstract

Aim: Consensus is lacking regarding the management of extramesorectal lymph nodes (EMLN) in rectal cancer. Using simultaneous integrated boost intensity-modulated radiation therapy (SIB-IMRT), we targeted involved EMLN and reserved lateral pelvic lymph nodal dissection (LPLND) for nonresponders. The primary aim of this work was to determine the proportion of patients who avoided LPLND and to establish the pathological EMLN positivity rate.

Method: Consecutive patients with rectal cancer with suspicious EMLN [short axis dimension (SAD) ≥ 7 mm], receiving SIB-IMRT as part of neoadjuvant chemoradiotherapy and subsequently undergoing total mesorectal excision (TME) or watch-and-wait, were included. Our primary objective was to determine the proportion of patients with a good nodal response (EMLN SAD < 5 mm) who were spared LPLND. The 3-year locoregional relapse rate, distant metastasis-free survival (DMFS) and overall survival (OS) were also assessed.

Results: Of the 61 patients studied, 38 (62.3%) responded well to SIB-IMRT. In this group, 32 patients underwent TME alone and six were observed as per watch-and-wait. The remaining 23 (37.7%) patients with persistent EMLN received TME with LPLND. On pathological evaluation, 7 (30.4%) patients had positive nodes while 16 (69.6%) were negative. At a median follow-up of 32 months (95% CI 23.3-40.7 months), 10 (16.4%) patients developed distant metastases while none had local or pelvic relapse. The resultant 3-year DMFS and OS for the whole cohort were 84.4% and 95.1%, respectively. Overall, 5/61 (8.2%) patients encountered radiation-induced toxicity of grade 3 or above and 8/55 (14.5%) patients had severe postoperative complications.

Conclusion: SIB-IMRT targeting EMLN followed by selective LPLND exhibits excellent oncological outcomes. While patients responding to SIB-IMRT safely avoid LPLND, the potential for increased morbidity in nonresponders must be considered.

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来源期刊

Colorectal Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

11.80%

发文量

406

审稿时长

1.5 months

期刊介绍： Diseases of the colon and rectum are common and offer a number of exciting challenges. Clinical, diagnostic and basic science research is expanding rapidly. There is increasing demand from purchasers of health care and patients for clinicians to keep abreast of the latest research and developments, and to translate these into routine practice. Technological advances in diagnosis, surgical technique, new pharmaceuticals, molecular genetics and other basic sciences have transformed many aspects of how these diseases are managed. Such progress will accelerate. Colorectal Disease offers a real benefit to subscribers and authors. It is first and foremost a vehicle for publishing original research relating to the demanding, rapidly expanding field of colorectal diseases. Essential for surgeons, pathologists, oncologists, gastroenterologists and health professionals caring for patients with a disease of the lower GI tract, Colorectal Disease furthers education and inter-professional development by including regular review articles and discussions of current controversies. Note that the journal does not usually accept paediatric surgical papers.