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The Role of Simultaneous Integrated Boost in Locally Advanced Rectal Cancer Patients with Positive Lateral Pelvic Lymph Nodes

SIMPLE SUMMARY: Around 15% of locally advanced rectal cancer patients have positive lateral pelvic lymph-nodes at diagnosis, with a worse prognosis due to the high incidence of distant metastasis. The best treatment modality for these patients is still a challenge. The aim of our retrospective study...

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Autores principales: Meldolesi, Elisa, Chiloiro, Giuditta, Giannini, Roberta, Menghi, Roberta, Persiani, Roberto, Corvari, Barbara, Coco, Claudio, Manfrida, Stefania, Ratto, Carlo, De Luca, Viola, Sofo, Luigi, Reina, Sara, Crucitti, Antonio, Masiello, Valeria, Dinapoli, Nicola, Valentini, Vincenzo, Gambacorta, Maria Antonietta
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8996944/
https://www.ncbi.nlm.nih.gov/pubmed/35406415
http://dx.doi.org/10.3390/cancers14071643
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author Meldolesi, Elisa
Chiloiro, Giuditta
Giannini, Roberta
Menghi, Roberta
Persiani, Roberto
Corvari, Barbara
Coco, Claudio
Manfrida, Stefania
Ratto, Carlo
De Luca, Viola
Sofo, Luigi
Reina, Sara
Crucitti, Antonio
Masiello, Valeria
Dinapoli, Nicola
Valentini, Vincenzo
Gambacorta, Maria Antonietta
author_facet Meldolesi, Elisa
Chiloiro, Giuditta
Giannini, Roberta
Menghi, Roberta
Persiani, Roberto
Corvari, Barbara
Coco, Claudio
Manfrida, Stefania
Ratto, Carlo
De Luca, Viola
Sofo, Luigi
Reina, Sara
Crucitti, Antonio
Masiello, Valeria
Dinapoli, Nicola
Valentini, Vincenzo
Gambacorta, Maria Antonietta
author_sort Meldolesi, Elisa
collection PubMed
description SIMPLE SUMMARY: Around 15% of locally advanced rectal cancer patients have positive lateral pelvic lymph-nodes at diagnosis, with a worse prognosis due to the high incidence of distant metastasis. The best treatment modality for these patients is still a challenge. The aim of our retrospective study was to analyze the efficacy of the Simultaneous Integrated Boost—Intensity Modulated Radiation Therapy technique and determine the optimal dose of radiotherapy on clinically positive lateral pelvic lymph-nodes in locally advanced rectal cancer patients. Excellent results in terms of all the analyzed oncological outcomes have been observed. These results, if validated by future prospective studies, can bring a valid alternative to the surgery dissection without the important side effects and permanent disabilities observed during the years. ABSTRACT: Aims: Between 11 to 14% of patients with locally advanced rectal cancer (LARC) have positive lateral pelvic lymph nodes (LPLN) at diagnosis, related to a worse prognosis with a 5-year survival rate between 30 to 40%. The best treatment choice for this group of patients is still a challenge. The optimal radiotherapy (RT) dose for LPLN patients has been investigated. Methods: We retrospectively collected data from LARC patients with LPLN at the primary staging MRI, treated in our center from March 2003 to December 2020. Patients underwent a neoadjuvant concomitant chemo-radiotherapy (CRT) treatment on the primary tumor (T), mesorectum, and pelvic nodes, associated with a fluoride-based chemotherapy. The total reached dose was 45 Gy at 1.8 Gy/fr on the elective sites and 55 Gy at 2.2 Gy/fr on the disease and mesorectum. Patients were divided in two groups based on whether they received a simultaneous integrated RT boost on the LPLN or not. Overall Survival (OS), Disease Free Survival (DFS), Metastasis Free Survival (MFS), and Local Control (LC) were evaluated in the whole group and then compared between the two groups. Results: A total of 176 patients were evaluated: 82 were included in the RT boost group and 94 in the non-RT boost group. The median follow-up period was 57.8 months. All the clinical endpoint (OS, DFS, MFS, LC), resulted were affected by the simultaneous integrated boost on LPLN with a survival rate of 84.7%, 79.5%, 84.1%, and 92%, respectively, in the entire population. From the comparison of the two groups, there was a statistical significance towards the RT boost group with a p < 0.006, 0.030, 0.042, 0.026, respectively. Conclusions: Concomitant radiotherapy boost on positive LPLN has shown to be beneficial on the survival outcomes (OS, DFS, MFR, and LC) in patients with LARC and LPLN. This analysis demonstrates that a higher dose of radiotherapy on positive pelvic lymph nodes led not only to a higher local control but also to a better survival rate. These results, if validated by future prospective studies, can bring a valid alternative to the surgery dissection without the important side effects and permanent disabilities observed during the years.
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spelling pubmed-89969442022-04-12 The Role of Simultaneous Integrated Boost in Locally Advanced Rectal Cancer Patients with Positive Lateral Pelvic Lymph Nodes Meldolesi, Elisa Chiloiro, Giuditta Giannini, Roberta Menghi, Roberta Persiani, Roberto Corvari, Barbara Coco, Claudio Manfrida, Stefania Ratto, Carlo De Luca, Viola Sofo, Luigi Reina, Sara Crucitti, Antonio Masiello, Valeria Dinapoli, Nicola Valentini, Vincenzo Gambacorta, Maria Antonietta Cancers (Basel) Article SIMPLE SUMMARY: Around 15% of locally advanced rectal cancer patients have positive lateral pelvic lymph-nodes at diagnosis, with a worse prognosis due to the high incidence of distant metastasis. The best treatment modality for these patients is still a challenge. The aim of our retrospective study was to analyze the efficacy of the Simultaneous Integrated Boost—Intensity Modulated Radiation Therapy technique and determine the optimal dose of radiotherapy on clinically positive lateral pelvic lymph-nodes in locally advanced rectal cancer patients. Excellent results in terms of all the analyzed oncological outcomes have been observed. These results, if validated by future prospective studies, can bring a valid alternative to the surgery dissection without the important side effects and permanent disabilities observed during the years. ABSTRACT: Aims: Between 11 to 14% of patients with locally advanced rectal cancer (LARC) have positive lateral pelvic lymph nodes (LPLN) at diagnosis, related to a worse prognosis with a 5-year survival rate between 30 to 40%. The best treatment choice for this group of patients is still a challenge. The optimal radiotherapy (RT) dose for LPLN patients has been investigated. Methods: We retrospectively collected data from LARC patients with LPLN at the primary staging MRI, treated in our center from March 2003 to December 2020. Patients underwent a neoadjuvant concomitant chemo-radiotherapy (CRT) treatment on the primary tumor (T), mesorectum, and pelvic nodes, associated with a fluoride-based chemotherapy. The total reached dose was 45 Gy at 1.8 Gy/fr on the elective sites and 55 Gy at 2.2 Gy/fr on the disease and mesorectum. Patients were divided in two groups based on whether they received a simultaneous integrated RT boost on the LPLN or not. Overall Survival (OS), Disease Free Survival (DFS), Metastasis Free Survival (MFS), and Local Control (LC) were evaluated in the whole group and then compared between the two groups. Results: A total of 176 patients were evaluated: 82 were included in the RT boost group and 94 in the non-RT boost group. The median follow-up period was 57.8 months. All the clinical endpoint (OS, DFS, MFS, LC), resulted were affected by the simultaneous integrated boost on LPLN with a survival rate of 84.7%, 79.5%, 84.1%, and 92%, respectively, in the entire population. From the comparison of the two groups, there was a statistical significance towards the RT boost group with a p < 0.006, 0.030, 0.042, 0.026, respectively. Conclusions: Concomitant radiotherapy boost on positive LPLN has shown to be beneficial on the survival outcomes (OS, DFS, MFR, and LC) in patients with LARC and LPLN. This analysis demonstrates that a higher dose of radiotherapy on positive pelvic lymph nodes led not only to a higher local control but also to a better survival rate. These results, if validated by future prospective studies, can bring a valid alternative to the surgery dissection without the important side effects and permanent disabilities observed during the years. MDPI 2022-03-24 /pmc/articles/PMC8996944/ /pubmed/35406415 http://dx.doi.org/10.3390/cancers14071643 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Meldolesi, Elisa
Chiloiro, Giuditta
Giannini, Roberta
Menghi, Roberta
Persiani, Roberto
Corvari, Barbara
Coco, Claudio
Manfrida, Stefania
Ratto, Carlo
De Luca, Viola
Sofo, Luigi
Reina, Sara
Crucitti, Antonio
Masiello, Valeria
Dinapoli, Nicola
Valentini, Vincenzo
Gambacorta, Maria Antonietta
The Role of Simultaneous Integrated Boost in Locally Advanced Rectal Cancer Patients with Positive Lateral Pelvic Lymph Nodes
title The Role of Simultaneous Integrated Boost in Locally Advanced Rectal Cancer Patients with Positive Lateral Pelvic Lymph Nodes
title_full The Role of Simultaneous Integrated Boost in Locally Advanced Rectal Cancer Patients with Positive Lateral Pelvic Lymph Nodes
title_fullStr The Role of Simultaneous Integrated Boost in Locally Advanced Rectal Cancer Patients with Positive Lateral Pelvic Lymph Nodes
title_full_unstemmed The Role of Simultaneous Integrated Boost in Locally Advanced Rectal Cancer Patients with Positive Lateral Pelvic Lymph Nodes
title_short The Role of Simultaneous Integrated Boost in Locally Advanced Rectal Cancer Patients with Positive Lateral Pelvic Lymph Nodes
title_sort role of simultaneous integrated boost in locally advanced rectal cancer patients with positive lateral pelvic lymph nodes
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8996944/
https://www.ncbi.nlm.nih.gov/pubmed/35406415
http://dx.doi.org/10.3390/cancers14071643
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