Neoadjuvant therapy for lateral pelvic lymph nodes: choosing between long course chemoradiation or short course radiotherapy with consolidation chemotherapy.
Subhathira Manohkaran, T Vispute, A Mor, K Prakash, M Kazi, A Sharma, S K Ankathi, A Desouza, A Saklani
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引用次数: 0
Abstract
Background: The response of lateral pelvic lymph nodes (LPLNs) to various neoadjuvant treatments has not been thoroughly investigated. This study aims to compare the effects of long-course chemoradiotherapy (LCCRT) and total neoadjuvant therapy (TNT), i.e., short-course radiotherapy (SCRT) with consolidation chemotherapy, on LPLNs size reduction. The secondary objective is to compare the pathological positivity rates of LPLNs dissection (LPLND) postneoadjuvant treatment.
Methods: This is a retrospective analysis based on a prospectively maintained database. Patients with rectal cancer registered between January 2020 and December 2021 with radiologically positive LPLNs who underwent neoadjuvant radiation therapy were included. Patients were divided into two groups: LCCRT and TNT.
Results: Among 1200 registered rectal cancer cases, 160 had positive LPLNs, with 142 included in the analysis. A total of 61 patients received LCCRT, and 81 patients received TNT. No significant differences were found in tumor (T) and node (N) staging between the groups. However, the TNT cohort had a significantly higher proportion of patients with metastases (p < 0.001), poorly differentiated tumors (p = 0.021), and extramural venous invasion (p = 0.002). Baseline mean nodal sizes were similar between groups. Postneoadjuvant nodal sizes were 5.3 mm for LCCRT and 6.2 mm for TNT, with mean reductions of 5.7 mm and 4.6 mm, respectively (p = 0.136 and 0.54). Surgery was conducted in 77% of the LCCRT group and 59% of the TNT group, with 22 (46.8%) and 26 (54.1%) undergoing LPLND in their respective groups. The pathological positivity rates for LPLNs were similar (27.3% versus 23.1%, p = 0.731).
Conclusions: SCRT with consolidation chemotherapy does not provide a significant advantage over LCCRT in reducing LPLNs size or reducing the need for LPLND.
期刊介绍：
Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work.
Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.
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