Mapping of lateral pelvic lymph node recurrences in rectal cancer

a radiation oncologist’s perspective

Seo Hee Choi, Jee Suk Chang, Hong In Yoon, Dong Su Jang, Namkyu Kim, Joon Seok Lim, Byung So Min, Hyuk Huh, Sang Joon Shin, Joong Bae Ahn, Woong Sub Koom

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Purpose: Patterns of locoregional rectal cancer recurrences following total mesorectal excision (TME) were analyzed to define the irradiation volume, especially the lateral pelvic lymph node (LPLN). Materials and methods: Of 1243 patients who underwent TME without pelvic radiotherapy between 2005 and 2012, the data of 826 patients with rectal adenocarcinoma without distant metastases were analyzed for relapse patterns, categorized as distant and locoregional (anastomosis, mesorectum, presacral area, and LPLNs) failure. Results: The median follow-up was 61.8 months. The 5-year local recurrence-free, distant metastasis-free, overall survival rates were 88, 82, and 89%, respectively. Relapse occurred in 108 (13%) patients: 90 (11%) had distant and 28 (3%) had locoregional failure. Eight patients had LPLN recurrence: the 2 recurrences from upper rectal cancers occurred near the bifurcation of the common iliac artery into the external and internal iliac vessels; the 6 mid-lower rectal cancers had 16 recurrences near the internal iliac and obturator arteries—five occurred anterior to the obturator artery and posterior to the external iliac artery, superior to the femoral head. LPLN recurrence was associated with pN2 stage, perinodal extension, and lymphovascular invasion. Conclusion: The LPLN component of pre- or postoperative irradiation volumes could potentially be optimized based on our mapping data. However, since patients in our institution at high risk for relapse received either preoperative or postoperative chemoradiation, further analyses are needed to confirm our findings.

Original languageEnglish
Pages (from-to)1119-1128
Number of pages10
JournalJournal of cancer research and clinical oncology
Volume144
Issue number6
DOIs
Publication statusPublished - 2018 Jun 1

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Rectal Neoplasms
Lymph Nodes
Recurrence
Iliac Artery
Neoplasm Metastasis
Radiation Oncologists
Thigh
Adenocarcinoma
Radiotherapy
Survival Rate
Arteries

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Choi, Seo Hee ; Chang, Jee Suk ; Yoon, Hong In ; Jang, Dong Su ; Kim, Namkyu ; Lim, Joon Seok ; Min, Byung So ; Huh, Hyuk ; Shin, Sang Joon ; Ahn, Joong Bae ; Koom, Woong Sub. / Mapping of lateral pelvic lymph node recurrences in rectal cancer : a radiation oncologist’s perspective. In: Journal of cancer research and clinical oncology. 2018 ; Vol. 144, No. 6. pp. 1119-1128.
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title = "Mapping of lateral pelvic lymph node recurrences in rectal cancer: a radiation oncologist’s perspective",
abstract = "Purpose: Patterns of locoregional rectal cancer recurrences following total mesorectal excision (TME) were analyzed to define the irradiation volume, especially the lateral pelvic lymph node (LPLN). Materials and methods: Of 1243 patients who underwent TME without pelvic radiotherapy between 2005 and 2012, the data of 826 patients with rectal adenocarcinoma without distant metastases were analyzed for relapse patterns, categorized as distant and locoregional (anastomosis, mesorectum, presacral area, and LPLNs) failure. Results: The median follow-up was 61.8 months. The 5-year local recurrence-free, distant metastasis-free, overall survival rates were 88, 82, and 89{\%}, respectively. Relapse occurred in 108 (13{\%}) patients: 90 (11{\%}) had distant and 28 (3{\%}) had locoregional failure. Eight patients had LPLN recurrence: the 2 recurrences from upper rectal cancers occurred near the bifurcation of the common iliac artery into the external and internal iliac vessels; the 6 mid-lower rectal cancers had 16 recurrences near the internal iliac and obturator arteries—five occurred anterior to the obturator artery and posterior to the external iliac artery, superior to the femoral head. LPLN recurrence was associated with pN2 stage, perinodal extension, and lymphovascular invasion. Conclusion: The LPLN component of pre- or postoperative irradiation volumes could potentially be optimized based on our mapping data. However, since patients in our institution at high risk for relapse received either preoperative or postoperative chemoradiation, further analyses are needed to confirm our findings.",
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Choi, SH, Chang, JS, Yoon, HI, Jang, DS, Kim, N, Lim, JS, Min, BS, Huh, H, Shin, SJ, Ahn, JB & Koom, WS 2018, 'Mapping of lateral pelvic lymph node recurrences in rectal cancer: a radiation oncologist’s perspective', Journal of cancer research and clinical oncology, vol. 144, no. 6, pp. 1119-1128. https://doi.org/10.1007/s00432-018-2624-6

Mapping of lateral pelvic lymph node recurrences in rectal cancer : a radiation oncologist’s perspective. / Choi, Seo Hee; Chang, Jee Suk; Yoon, Hong In; Jang, Dong Su; Kim, Namkyu; Lim, Joon Seok; Min, Byung So; Huh, Hyuk; Shin, Sang Joon; Ahn, Joong Bae; Koom, Woong Sub.

In: Journal of cancer research and clinical oncology, Vol. 144, No. 6, 01.06.2018, p. 1119-1128.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Mapping of lateral pelvic lymph node recurrences in rectal cancer

T2 - a radiation oncologist’s perspective

AU - Choi, Seo Hee

AU - Chang, Jee Suk

AU - Yoon, Hong In

AU - Jang, Dong Su

AU - Kim, Namkyu

AU - Lim, Joon Seok

AU - Min, Byung So

AU - Huh, Hyuk

AU - Shin, Sang Joon

AU - Ahn, Joong Bae

AU - Koom, Woong Sub

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Purpose: Patterns of locoregional rectal cancer recurrences following total mesorectal excision (TME) were analyzed to define the irradiation volume, especially the lateral pelvic lymph node (LPLN). Materials and methods: Of 1243 patients who underwent TME without pelvic radiotherapy between 2005 and 2012, the data of 826 patients with rectal adenocarcinoma without distant metastases were analyzed for relapse patterns, categorized as distant and locoregional (anastomosis, mesorectum, presacral area, and LPLNs) failure. Results: The median follow-up was 61.8 months. The 5-year local recurrence-free, distant metastasis-free, overall survival rates were 88, 82, and 89%, respectively. Relapse occurred in 108 (13%) patients: 90 (11%) had distant and 28 (3%) had locoregional failure. Eight patients had LPLN recurrence: the 2 recurrences from upper rectal cancers occurred near the bifurcation of the common iliac artery into the external and internal iliac vessels; the 6 mid-lower rectal cancers had 16 recurrences near the internal iliac and obturator arteries—five occurred anterior to the obturator artery and posterior to the external iliac artery, superior to the femoral head. LPLN recurrence was associated with pN2 stage, perinodal extension, and lymphovascular invasion. Conclusion: The LPLN component of pre- or postoperative irradiation volumes could potentially be optimized based on our mapping data. However, since patients in our institution at high risk for relapse received either preoperative or postoperative chemoradiation, further analyses are needed to confirm our findings.

AB - Purpose: Patterns of locoregional rectal cancer recurrences following total mesorectal excision (TME) were analyzed to define the irradiation volume, especially the lateral pelvic lymph node (LPLN). Materials and methods: Of 1243 patients who underwent TME without pelvic radiotherapy between 2005 and 2012, the data of 826 patients with rectal adenocarcinoma without distant metastases were analyzed for relapse patterns, categorized as distant and locoregional (anastomosis, mesorectum, presacral area, and LPLNs) failure. Results: The median follow-up was 61.8 months. The 5-year local recurrence-free, distant metastasis-free, overall survival rates were 88, 82, and 89%, respectively. Relapse occurred in 108 (13%) patients: 90 (11%) had distant and 28 (3%) had locoregional failure. Eight patients had LPLN recurrence: the 2 recurrences from upper rectal cancers occurred near the bifurcation of the common iliac artery into the external and internal iliac vessels; the 6 mid-lower rectal cancers had 16 recurrences near the internal iliac and obturator arteries—five occurred anterior to the obturator artery and posterior to the external iliac artery, superior to the femoral head. LPLN recurrence was associated with pN2 stage, perinodal extension, and lymphovascular invasion. Conclusion: The LPLN component of pre- or postoperative irradiation volumes could potentially be optimized based on our mapping data. However, since patients in our institution at high risk for relapse received either preoperative or postoperative chemoradiation, further analyses are needed to confirm our findings.

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