TY - JOUR
T1 - Neoadjuvant (Chemo)radiotherapy With Total Mesorectal Excision Only Is Not Sufficient to Prevent Lateral Local Recurrence in Enlarged Nodes
T2 - Results of the Multicenter Lateral Node Study of Patients With Low cT3/4 Rectal Cancer
AU - Ogura, Atsushi
AU - Konishi, Tsuyoshi
AU - Cunningham, Chris
AU - Garcia-Aguilar, Julio
AU - Iversen, Henrik
AU - Toda, Shigeo
AU - Lee, In Kyu
AU - Lee, Hong Xiang
AU - Uehara, Keisuke
AU - Lee, Peter
AU - Putter, Hein
AU - van de Velde, Cornelis J. H.
AU - Beets, Geerard L.
AU - Rutten, Harm J. T.
AU - Kusters, Miranda
AU - Aalbers, A. G. J.
AU - Aiba, T.
AU - Akiyoshi, T.
AU - Beets-Tan, R. G. H.
AU - Betts, M.
AU - Blazic, I. M.
AU - Brown, K. G.
AU - Campbell, N.
AU - Choi, M. H.
AU - Gollub, M. J.
AU - Hanaoka, Y.
AU - Kim, M. K.
AU - Meershoek-Klein-Kranenbarg, E.
AU - Kuroyanagi, H.
AU - Maas, M.
AU - Martling, A.
AU - Moore, J.
AU - Nieuwenhuijzen, G. A.
AU - Oh, S. N.
AU - Roodbeen, S.
AU - Sammour, T.
AU - Schaap, D.
AU - Solomon, M. J.
AU - Thomas, M.
AU - Tomizawa, K.
AU - van der Sande, M. E.
AU - Suzuki, C.
AU - van der Valk, M. J. M.
AU - Wells, T.
AU - Won, D. D.
AU - Lateral Node Study Consortium
N1 - Publisher Copyright:
© 2018 by American Society of Clinical Oncology.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - PurposeImprovements in magnetic resonance imaging (MRI), total mesorectal excision (TME) surgery, and the use of (chemo)radiotherapy ([C]RT) have improved local control of rectal cancer; however, we have been unable to eradicate local recurrence (LR). Even in the face of TME and negative resection margins (R0), a significant proportion of patients with enlarged lateral lymph nodes (LLNs) suffer from lateral LR (LLR). Japanese studies suggest that the addition of an LLN dissection (LLND) could reduce LLR. This multicenter pooled analysis aims to ascertain whether LLNs actually pose a problem and whether LLND results in fewer LLRs.Patients and MethodsData from 1,216 consecutive patients with cT3/T4 rectal cancers up to 8 cm from the anal verge who underwent surgery in a 5-year period were collected. LLND was performed in 142 patients (12%). MRIs were re-evaluated with a standardized protocol to assess LLN features.ResultsOn pretreatment MRI, 703 patients (58%) had visible LLN, and 192 (16%) had a short axis of at least 7 mm. One hundred eight patients developed LR (5-year LR rate, 10.0%), of which 59 (54%) were LLRs (5-year LLR rate, 5.5%). After multivariable analyses, LLNs with a short axis of at least 7 mm resulted in a significantly higher risk of LLR (hazard ratio, 2.060; P = .045) compared with LLNs of less than 7 mm. In patients with LLNs at least 7 mm, (C)RT plus TME plus LLND resulted in a 5-year LLR of 5.7%, which was significantly lower than that in patients who underwent (C)RT plus TME (5-year LLR, 19.5%; P = .042).ConclusionLLR is still a significant problem after (C)RT plus TME in LLNs with a short axis at least 7 mm on pretreatment MRI. The addition of LLND results in a significantly lower LLR rate.
AB - PurposeImprovements in magnetic resonance imaging (MRI), total mesorectal excision (TME) surgery, and the use of (chemo)radiotherapy ([C]RT) have improved local control of rectal cancer; however, we have been unable to eradicate local recurrence (LR). Even in the face of TME and negative resection margins (R0), a significant proportion of patients with enlarged lateral lymph nodes (LLNs) suffer from lateral LR (LLR). Japanese studies suggest that the addition of an LLN dissection (LLND) could reduce LLR. This multicenter pooled analysis aims to ascertain whether LLNs actually pose a problem and whether LLND results in fewer LLRs.Patients and MethodsData from 1,216 consecutive patients with cT3/T4 rectal cancers up to 8 cm from the anal verge who underwent surgery in a 5-year period were collected. LLND was performed in 142 patients (12%). MRIs were re-evaluated with a standardized protocol to assess LLN features.ResultsOn pretreatment MRI, 703 patients (58%) had visible LLN, and 192 (16%) had a short axis of at least 7 mm. One hundred eight patients developed LR (5-year LR rate, 10.0%), of which 59 (54%) were LLRs (5-year LLR rate, 5.5%). After multivariable analyses, LLNs with a short axis of at least 7 mm resulted in a significantly higher risk of LLR (hazard ratio, 2.060; P = .045) compared with LLNs of less than 7 mm. In patients with LLNs at least 7 mm, (C)RT plus TME plus LLND resulted in a 5-year LLR of 5.7%, which was significantly lower than that in patients who underwent (C)RT plus TME (5-year LLR, 19.5%; P = .042).ConclusionLLR is still a significant problem after (C)RT plus TME in LLNs with a short axis at least 7 mm on pretreatment MRI. The addition of LLND results in a significantly lower LLR rate.
KW - PREOPERATIVE CHEMORADIOTHERAPY
KW - RESECTION MARGIN
KW - DISSECTION
KW - METASTASIS
KW - RADIOTHERAPY
KW - SURVIVAL
KW - DISEASE
KW - JAPAN
U2 - 10.1200/JCO.18.00032
DO - 10.1200/JCO.18.00032
M3 - Article
C2 - 30403572
SN - 0732-183X
VL - 37
SP - 33
EP - 43
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 1
ER -