TY - JOUR
T1 - Lateral Lymph Node Metastases in Locally Advanced Low Rectal Cancers May Not Be Treated Effectively With Neoadjuvant (Chemo)Radiotherapy Only
AU - Haanappel, Anouck
AU - Kroon, Hidde M.
AU - Schaap, Dennis P.
AU - Bedrikovetski, Sergei
AU - Dudi-Venkata, Nagendra N.
AU - Lee, Hong X.
AU - Thomas, Michelle L.
AU - Liu, Jianliang
AU - van der Valk, Maxime J. M.
AU - Rutten, Harm J. T.
AU - Beets, Geerard L.
AU - Kusters, Miranda
AU - Sammour, Tarik
N1 - Funding Information:
AH was supported by the Stichting Prof. Michaël-van Vloten Fonds, Stichting Bekker-la Bastide-Fonds, Stichting Dr. Hendrik Muller’s Vaderlandsch Fonds, and Stichting Sacha Swarttouw-Hijmans.
Publisher Copyright:
© Copyright © 2019 Haanappel, Kroon, Schaap, Bedrikovetski, Dudi-Venkata, Lee, Thomas, Liu, van der Valk, Rutten, Beets, Kusters and Sammour.
PY - 2019/12/3
Y1 - 2019/12/3
N2 - Background: In the West, pre-treatment abnormal lateral lymph nodes (LLN+) in patients with a low locally advanced rectal cancer (AJCC Stage III), are treated with neoadjuvant (chemo)radiotherapy (nCRT), without a lateral lymph node dissection (LLND). It has been suggested, however, that LLN+ patients have higher local recurrence (LR) rates than similarly staged patients with abnormal mesorectal lymph nodes only (LLN-), but no comparative data exist. Therefore, we conducted this international multi-center study in the Netherlands and Australia of Stage III rectal cancer patients with either LLN+ or LLN- to compare oncological outcomes from both groups. Materials and Methods: Patients with Stage III low rectal cancer with (LLN+ group) or without (LLN- group) abnormal lateral lymph nodes on pre-treatment MRI were included. Patients underwent nCRT followed by rectal resection surgery with curative intent between 2009 and 2016 with a minimum follow-up of 2-years. No patient had a LLND. Propensity score matching corrected differences in baseline characteristics. Results: Two hundred twenty-three patients could be included: 125 in the LLN+ group and 98 in the LLN- group. Between groups, there were significant differences in cT-stage and in the rate of adjuvant chemotherapy administered. Propensity score matching resulted in 54 patients in each group, with equal baseline characteristics. The 5-year LR rate in the LLN+ group was 11 vs. 2% in the LLN- group (P = 0.06) and disease-free survival (DFS) was 64 vs. 76%, respectively (P = 0.09). Five-year overall survival was similar between groups (73 vs. 80%, respectively; P = 0.90). Conclusions: In Western patients with Stage III low rectal cancer, there is a trend toward worse LR rate and DFS rates in LLN+ patients compared to similarly staged LLN- patients. These results suggest that LLN+ patients may currently not be treated optimally with nCRT alone, and the addition of LLND requires further consideration.
AB - Background: In the West, pre-treatment abnormal lateral lymph nodes (LLN+) in patients with a low locally advanced rectal cancer (AJCC Stage III), are treated with neoadjuvant (chemo)radiotherapy (nCRT), without a lateral lymph node dissection (LLND). It has been suggested, however, that LLN+ patients have higher local recurrence (LR) rates than similarly staged patients with abnormal mesorectal lymph nodes only (LLN-), but no comparative data exist. Therefore, we conducted this international multi-center study in the Netherlands and Australia of Stage III rectal cancer patients with either LLN+ or LLN- to compare oncological outcomes from both groups. Materials and Methods: Patients with Stage III low rectal cancer with (LLN+ group) or without (LLN- group) abnormal lateral lymph nodes on pre-treatment MRI were included. Patients underwent nCRT followed by rectal resection surgery with curative intent between 2009 and 2016 with a minimum follow-up of 2-years. No patient had a LLND. Propensity score matching corrected differences in baseline characteristics. Results: Two hundred twenty-three patients could be included: 125 in the LLN+ group and 98 in the LLN- group. Between groups, there were significant differences in cT-stage and in the rate of adjuvant chemotherapy administered. Propensity score matching resulted in 54 patients in each group, with equal baseline characteristics. The 5-year LR rate in the LLN+ group was 11 vs. 2% in the LLN- group (P = 0.06) and disease-free survival (DFS) was 64 vs. 76%, respectively (P = 0.09). Five-year overall survival was similar between groups (73 vs. 80%, respectively; P = 0.90). Conclusions: In Western patients with Stage III low rectal cancer, there is a trend toward worse LR rate and DFS rates in LLN+ patients compared to similarly staged LLN- patients. These results suggest that LLN+ patients may currently not be treated optimally with nCRT alone, and the addition of LLND requires further consideration.
KW - lateral lymph nodes
KW - locally advanced low rectal cancer
KW - neoadjuvant (chemo)radiotherapy
KW - oncological outcomes
KW - survival
KW - TOTAL MESORECTAL EXCISION
KW - PREOPERATIVE CHEMORADIOTHERAPY
KW - LOCOREGIONAL RECURRENCE
KW - MAJOR CAUSE
KW - DISSECTION
KW - INVOLVEMENT
KW - CHEMORADIATION
KW - RESECTION
KW - BENEFIT
U2 - 10.3389/fonc.2019.01355
DO - 10.3389/fonc.2019.01355
M3 - Article
C2 - 31850231
SN - 2234-943X
VL - 9
JO - Frontiers in Oncology
JF - Frontiers in Oncology
M1 - 1355
ER -