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

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Colorectal Disease Pub Date : 2025-01-22 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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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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针对局部晚期直肠癌临床受累直肠外淋巴结的同步综合增强调强放疗：一项回顾性研究

目的：对于直肠癌直肠外淋巴结（EMLN）的处理，目前还缺乏共识。采用同步综合增强调强放疗（sibb - imrt），我们针对无反应的受灶EMLN和保留盆腔外侧淋巴结清扫（LPLND）。本研究的主要目的是确定避免LPLND的患者比例，并确定病理性EMLN阳性率。方法：纳入可疑EMLN[短轴尺寸(SAD)≥7 mm]的连续直肠癌患者，接受sibb - imrt作为新辅助放化疗的一部分，随后进行全肠系膜切除（TME）或观察等待。我们的主要目的是确定具有良好淋巴结反应（EMLN SAD）的患者比例。结果：在61例研究患者中，38例（62.3%）对sibr - imrt反应良好。在本组中，32例患者单独接受TME治疗，6例患者按观察等待方式观察。其余23例（37.7%）持续性EMLN患者接受LPLND联合TME治疗。病理评价中淋巴结阳性7例（30.4%），阴性16例（69.6%）。在中位随访32个月（95% CI 23.3-40.7个月），10例（16.4%）患者发生远处转移，而没有局部或盆腔复发。整个队列的3年DMFS和OS分别为84.4%和95.1%。总体而言，5/61（8.2%）的患者出现了3级或以上的放射性毒性，8/55（14.5%）的患者出现了严重的术后并发症。结论：靶向EMLN的sibb - imrt和选择性LPLND具有良好的肿瘤预后。虽然对sibb - imrt有反应的患者可以安全地避免LPLND，但必须考虑无反应患者发病率增加的可能性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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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.