Incorporation of Radiotherapy in the Multidisciplinary Treatment of Isolated Retroperitoneal Lymph Node Recurrence from Colorectal Cancer

Jeongshim Lee, Jee Suk Chang, Sang Joon Shin, Joon Seok Lim, Ki Chang Keum, Namkyu Kim, Joong Bae Ahn, Tae Il Kim, Woong Sub Koom

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Purpose: This article was designed to study the clinical outcomes and prognostic factors following radiotherapy (RT) in the multidisciplinary management of isolated retroperitoneal lymph node (RPLN) recurrence of colorectal cancer. Methods: We identified 52 patients treated consecutively with tumor-directed RT for isolated RPLN recurrence. Twenty-five patients received upfront RT (Group 1). Twenty-seven patients received RT after systemic therapy. The deferred RT was administered either to locally controlled tumors (Group 2, n = 17) or to locally progressive tumors in RPLNs (Group 3, n = 10). Results: The median overall survival and progression-free survival were 41 and 13 months, respectively, with a median follow-up time of 34 months. Survival was not significantly different among three groups. Local recurrence (32/52) was predominant and occurred earlier than distant metastasis (31/52). Two-thirds of the local recurrences (21/32) involved outfield recurrence, which was mostly in the cranial direction (15/21) from the upper margin of the RT volume. Repeated RT successfully salvaged a substantial number of patients. A shorter disease-free interval, low-dose radiation, and a tumor location above the renal vein were independent risk factors for local recurrence (all P < 0.05). A large gross tumor volume was an independent risk factor for distant metastasis (P = 0.037). No acute or late RT-related toxicity ≥ grade 3 occurred. Conclusions: Our analysis suggests that both upfront RT and deferred RT incorporated into multidisciplinary management are potentially effective treatment strategies. We found that gross tumor volume, tumor location, and disease-free interval are important prognostic factors and should be taken into consideration to decide the timing of RT.

Original languageEnglish
Pages (from-to)1520-1526
Number of pages7
JournalAnnals of Surgical Oncology
Volume22
Issue number5
DOIs
Publication statusPublished - 2015 May 1

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Colorectal Neoplasms
Radiotherapy
Lymph Nodes
Recurrence
Therapeutics
Neoplasms
Tumor Burden
Neoplasm Metastasis
Renal Veins
Survival
Disease-Free Survival
Outcome Assessment (Health Care)
Radiation

All Science Journal Classification (ASJC) codes

  • Surgery
  • Oncology

Cite this

Lee, Jeongshim ; Chang, Jee Suk ; Shin, Sang Joon ; Lim, Joon Seok ; Keum, Ki Chang ; Kim, Namkyu ; Ahn, Joong Bae ; Kim, Tae Il ; Koom, Woong Sub. / Incorporation of Radiotherapy in the Multidisciplinary Treatment of Isolated Retroperitoneal Lymph Node Recurrence from Colorectal Cancer. In: Annals of Surgical Oncology. 2015 ; Vol. 22, No. 5. pp. 1520-1526.
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title = "Incorporation of Radiotherapy in the Multidisciplinary Treatment of Isolated Retroperitoneal Lymph Node Recurrence from Colorectal Cancer",
abstract = "Purpose: This article was designed to study the clinical outcomes and prognostic factors following radiotherapy (RT) in the multidisciplinary management of isolated retroperitoneal lymph node (RPLN) recurrence of colorectal cancer. Methods: We identified 52 patients treated consecutively with tumor-directed RT for isolated RPLN recurrence. Twenty-five patients received upfront RT (Group 1). Twenty-seven patients received RT after systemic therapy. The deferred RT was administered either to locally controlled tumors (Group 2, n = 17) or to locally progressive tumors in RPLNs (Group 3, n = 10). Results: The median overall survival and progression-free survival were 41 and 13 months, respectively, with a median follow-up time of 34 months. Survival was not significantly different among three groups. Local recurrence (32/52) was predominant and occurred earlier than distant metastasis (31/52). Two-thirds of the local recurrences (21/32) involved outfield recurrence, which was mostly in the cranial direction (15/21) from the upper margin of the RT volume. Repeated RT successfully salvaged a substantial number of patients. A shorter disease-free interval, low-dose radiation, and a tumor location above the renal vein were independent risk factors for local recurrence (all P < 0.05). A large gross tumor volume was an independent risk factor for distant metastasis (P = 0.037). No acute or late RT-related toxicity ≥ grade 3 occurred. Conclusions: Our analysis suggests that both upfront RT and deferred RT incorporated into multidisciplinary management are potentially effective treatment strategies. We found that gross tumor volume, tumor location, and disease-free interval are important prognostic factors and should be taken into consideration to decide the timing of RT.",
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Incorporation of Radiotherapy in the Multidisciplinary Treatment of Isolated Retroperitoneal Lymph Node Recurrence from Colorectal Cancer. / Lee, Jeongshim; Chang, Jee Suk; Shin, Sang Joon; Lim, Joon Seok; Keum, Ki Chang; Kim, Namkyu; Ahn, Joong Bae; Kim, Tae Il; Koom, Woong Sub.

In: Annals of Surgical Oncology, Vol. 22, No. 5, 01.05.2015, p. 1520-1526.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Incorporation of Radiotherapy in the Multidisciplinary Treatment of Isolated Retroperitoneal Lymph Node Recurrence from Colorectal Cancer

AU - Lee, Jeongshim

AU - Chang, Jee Suk

AU - Shin, Sang Joon

AU - Lim, Joon Seok

AU - Keum, Ki Chang

AU - Kim, Namkyu

AU - Ahn, Joong Bae

AU - Kim, Tae Il

AU - Koom, Woong Sub

PY - 2015/5/1

Y1 - 2015/5/1

N2 - Purpose: This article was designed to study the clinical outcomes and prognostic factors following radiotherapy (RT) in the multidisciplinary management of isolated retroperitoneal lymph node (RPLN) recurrence of colorectal cancer. Methods: We identified 52 patients treated consecutively with tumor-directed RT for isolated RPLN recurrence. Twenty-five patients received upfront RT (Group 1). Twenty-seven patients received RT after systemic therapy. The deferred RT was administered either to locally controlled tumors (Group 2, n = 17) or to locally progressive tumors in RPLNs (Group 3, n = 10). Results: The median overall survival and progression-free survival were 41 and 13 months, respectively, with a median follow-up time of 34 months. Survival was not significantly different among three groups. Local recurrence (32/52) was predominant and occurred earlier than distant metastasis (31/52). Two-thirds of the local recurrences (21/32) involved outfield recurrence, which was mostly in the cranial direction (15/21) from the upper margin of the RT volume. Repeated RT successfully salvaged a substantial number of patients. A shorter disease-free interval, low-dose radiation, and a tumor location above the renal vein were independent risk factors for local recurrence (all P < 0.05). A large gross tumor volume was an independent risk factor for distant metastasis (P = 0.037). No acute or late RT-related toxicity ≥ grade 3 occurred. Conclusions: Our analysis suggests that both upfront RT and deferred RT incorporated into multidisciplinary management are potentially effective treatment strategies. We found that gross tumor volume, tumor location, and disease-free interval are important prognostic factors and should be taken into consideration to decide the timing of RT.

AB - Purpose: This article was designed to study the clinical outcomes and prognostic factors following radiotherapy (RT) in the multidisciplinary management of isolated retroperitoneal lymph node (RPLN) recurrence of colorectal cancer. Methods: We identified 52 patients treated consecutively with tumor-directed RT for isolated RPLN recurrence. Twenty-five patients received upfront RT (Group 1). Twenty-seven patients received RT after systemic therapy. The deferred RT was administered either to locally controlled tumors (Group 2, n = 17) or to locally progressive tumors in RPLNs (Group 3, n = 10). Results: The median overall survival and progression-free survival were 41 and 13 months, respectively, with a median follow-up time of 34 months. Survival was not significantly different among three groups. Local recurrence (32/52) was predominant and occurred earlier than distant metastasis (31/52). Two-thirds of the local recurrences (21/32) involved outfield recurrence, which was mostly in the cranial direction (15/21) from the upper margin of the RT volume. Repeated RT successfully salvaged a substantial number of patients. A shorter disease-free interval, low-dose radiation, and a tumor location above the renal vein were independent risk factors for local recurrence (all P < 0.05). A large gross tumor volume was an independent risk factor for distant metastasis (P = 0.037). No acute or late RT-related toxicity ≥ grade 3 occurred. Conclusions: Our analysis suggests that both upfront RT and deferred RT incorporated into multidisciplinary management are potentially effective treatment strategies. We found that gross tumor volume, tumor location, and disease-free interval are important prognostic factors and should be taken into consideration to decide the timing of RT.

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