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Lateral Lymph Node Metastases in Locally Advanced Low Rectal Cancers May Not Be Treated Effectively With Neoadjuvant (Chemo)Radiotherapy Only

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+ patien...

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Autores principales: Haanappel, Anouck, Kroon, Hidde M., Schaap, Dennis P., Bedrikovetski, Sergei, Dudi-Venkata, Nagendra N., Lee, Hong X., Thomas, Michelle L., Liu, Jianliang, van der Valk, Maxime J. M., Rutten, Harm J. T., Beets, Geerard L., Kusters, Miranda, Sammour, Tarik
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6901685/
https://www.ncbi.nlm.nih.gov/pubmed/31850231
http://dx.doi.org/10.3389/fonc.2019.01355
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author Haanappel, Anouck
Kroon, Hidde M.
Schaap, Dennis P.
Bedrikovetski, Sergei
Dudi-Venkata, Nagendra N.
Lee, Hong X.
Thomas, Michelle L.
Liu, Jianliang
van der Valk, Maxime J. M.
Rutten, Harm J. T.
Beets, Geerard L.
Kusters, Miranda
Sammour, Tarik
author_facet Haanappel, Anouck
Kroon, Hidde M.
Schaap, Dennis P.
Bedrikovetski, Sergei
Dudi-Venkata, Nagendra N.
Lee, Hong X.
Thomas, Michelle L.
Liu, Jianliang
van der Valk, Maxime J. M.
Rutten, Harm J. T.
Beets, Geerard L.
Kusters, Miranda
Sammour, Tarik
author_sort Haanappel, Anouck
collection PubMed
description 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.
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spelling pubmed-69016852019-12-17 Lateral Lymph Node Metastases in Locally Advanced Low Rectal Cancers May Not Be Treated Effectively With Neoadjuvant (Chemo)Radiotherapy Only Haanappel, Anouck Kroon, Hidde M. Schaap, Dennis P. Bedrikovetski, Sergei Dudi-Venkata, Nagendra N. Lee, Hong X. Thomas, Michelle L. Liu, Jianliang van der Valk, Maxime J. M. Rutten, Harm J. T. Beets, Geerard L. Kusters, Miranda Sammour, Tarik Front Oncol Oncology 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. Frontiers Media S.A. 2019-12-03 /pmc/articles/PMC6901685/ /pubmed/31850231 http://dx.doi.org/10.3389/fonc.2019.01355 Text en Copyright © 2019 Haanappel, Kroon, Schaap, Bedrikovetski, Dudi-Venkata, Lee, Thomas, Liu, van der Valk, Rutten, Beets, Kusters and Sammour. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Haanappel, Anouck
Kroon, Hidde M.
Schaap, Dennis P.
Bedrikovetski, Sergei
Dudi-Venkata, Nagendra N.
Lee, Hong X.
Thomas, Michelle L.
Liu, Jianliang
van der Valk, Maxime J. M.
Rutten, Harm J. T.
Beets, Geerard L.
Kusters, Miranda
Sammour, Tarik
Lateral Lymph Node Metastases in Locally Advanced Low Rectal Cancers May Not Be Treated Effectively With Neoadjuvant (Chemo)Radiotherapy Only
title Lateral Lymph Node Metastases in Locally Advanced Low Rectal Cancers May Not Be Treated Effectively With Neoadjuvant (Chemo)Radiotherapy Only
title_full Lateral Lymph Node Metastases in Locally Advanced Low Rectal Cancers May Not Be Treated Effectively With Neoadjuvant (Chemo)Radiotherapy Only
title_fullStr Lateral Lymph Node Metastases in Locally Advanced Low Rectal Cancers May Not Be Treated Effectively With Neoadjuvant (Chemo)Radiotherapy Only
title_full_unstemmed Lateral Lymph Node Metastases in Locally Advanced Low Rectal Cancers May Not Be Treated Effectively With Neoadjuvant (Chemo)Radiotherapy Only
title_short Lateral Lymph Node Metastases in Locally Advanced Low Rectal Cancers May Not Be Treated Effectively With Neoadjuvant (Chemo)Radiotherapy Only
title_sort lateral lymph node metastases in locally advanced low rectal cancers may not be treated effectively with neoadjuvant (chemo)radiotherapy only
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6901685/
https://www.ncbi.nlm.nih.gov/pubmed/31850231
http://dx.doi.org/10.3389/fonc.2019.01355
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