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Good and complete responding locally advanced rectal tumors after chemoradiotherapy: where are the residual positive nodes located on restaging MRI?

PURPOSE: Aim of this study was to evaluate the distribution of persistent mesorectal lymph node metastases on restaging MRI in patients with a good or complete response of their primary tumor (ypT0-2) after CRT for locally advanced rectal cancer. METHODS: Two hundred and twenty eight locally advance...

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Detalles Bibliográficos
Autores principales: Heijnen, Luc A., Lambregts, Doenja M. J., Lahaye, Max J., Martens, Milou H., van Nijnatten, Thiemo J. A., Rao, Sheng-Xiang, Riedl, Robert G., Buijsen, Jeroen, Maas, Monique, Beets, Geerard L., Beets-Tan, Regina G. H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4912594/
https://www.ncbi.nlm.nih.gov/pubmed/26814499
http://dx.doi.org/10.1007/s00261-016-0640-z
Descripción
Sumario:PURPOSE: Aim of this study was to evaluate the distribution of persistent mesorectal lymph node metastases on restaging MRI in patients with a good or complete response of their primary tumor (ypT0-2) after CRT for locally advanced rectal cancer. METHODS: Two hundred and twenty eight locally advanced rectal cancer patients underwent CRT, which resulted in a good response (downstaging to yT0-2) in 144 patients. Forty-nine patients were excluded (no surgery/insufficient follow-up or lacking lesion-by-lesion histology results). This resulted in a final study group of 95 yT0-2 patients. For the patients with a yN(+)-status, a detailed lesion-by-lesion comparison between restaging MRI and histology was performed to evaluate the characteristics and distribution of the individual N(+)-nodes. RESULTS: 7/95 patients (7%) had a yT0-2N(+) status (11/880 (1%) N(+) nodes): no N(+) were found below the tumor level, 55% of the N(+) nodes were located at the level of the tumor, and 45% proximal to the tumor (at a median distance of 1.4 cm above the tumor level). In axial plane, 82% of the nodes were located at the ipsilateral circumference of the tumor, at a median distance of 0.9 cm from the tumor/rectal wall. CONCLUSIONS: The incidence of persistent metastatic mesorectal nodes after CRT in patients with a good tumor response after CRT is very low. No N(+) nodes are found below the tumor level. All N(+) nodes are located at the level of or proximal to the primary tumor, of which the majority very close to the tumor/lumen.