Lateral Lymph Node Metastases in Locally Advanced Low Rectal Cancers May Not Be Treated Effectively With Neoadjuvant (Chemo)Radiotherapy Only
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 high...
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Published in | Frontiers in oncology Vol. 9; p. 1355 |
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Main Authors | , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
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03.12.2019
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Abstract | 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.
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.
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 (
= 0.06) and disease-free survival (DFS) was 64 vs. 76%, respectively (
= 0.09). Five-year overall survival was similar between groups (73 vs. 80%, respectively;
= 0.90).
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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AbstractList | 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. 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. 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. 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 ( = 0.06) and disease-free survival (DFS) was 64 vs. 76%, respectively ( = 0.09). Five-year overall survival was similar between groups (73 vs. 80%, respectively; = 0.90). 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. 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. |
Author | Rutten, Harm J T Bedrikovetski, Sergei Sammour, Tarik Kusters, Miranda Kroon, Hidde M Schaap, Dennis P Beets, Geerard L van der Valk, Maxime J M Dudi-Venkata, Nagendra N Thomas, Michelle L Haanappel, Anouck Lee, Hong X Liu, Jianliang |
AuthorAffiliation | 2 Department of Surgery, Amsterdam University Medical Centers , Amsterdam , Netherlands 3 Department of Surgery, Catharina Hospital , Eindhoven , Netherlands 6 GROW, School of Oncology and Developmental Biology, University of Maastricht , Maastricht , Netherlands 7 Department of Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek , Amsterdam , Netherlands 4 Discipline of Surgery, Faculty of Health and Medical Science, School of Medicine, University of Adelaide , Adelaide, SA , Australia 5 Department of Surgery, Leiden University Medical Center , Leiden , Netherlands 1 Colorectal Unit, Department of Surgery, Royal Adelaide Hospital , Adelaide, SA , Australia |
AuthorAffiliation_xml | – name: 5 Department of Surgery, Leiden University Medical Center , Leiden , Netherlands – name: 6 GROW, School of Oncology and Developmental Biology, University of Maastricht , Maastricht , Netherlands – name: 1 Colorectal Unit, Department of Surgery, Royal Adelaide Hospital , Adelaide, SA , Australia – name: 4 Discipline of Surgery, Faculty of Health and Medical Science, School of Medicine, University of Adelaide , Adelaide, SA , Australia – name: 7 Department of Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek , Amsterdam , Netherlands – name: 2 Department of Surgery, Amsterdam University Medical Centers , Amsterdam , Netherlands – name: 3 Department of Surgery, Catharina Hospital , Eindhoven , Netherlands |
Author_xml | – sequence: 1 givenname: Anouck surname: Haanappel fullname: Haanappel, Anouck organization: Department of Surgery, Amsterdam University Medical Centers, Amsterdam, Netherlands – sequence: 2 givenname: Hidde M surname: Kroon fullname: Kroon, Hidde M organization: Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia – sequence: 3 givenname: Dennis P surname: Schaap fullname: Schaap, Dennis P organization: Department of Surgery, Catharina Hospital, Eindhoven, Netherlands – sequence: 4 givenname: Sergei surname: Bedrikovetski fullname: Bedrikovetski, Sergei organization: Discipline of Surgery, Faculty of Health and Medical Science, School of Medicine, University of Adelaide, Adelaide, SA, Australia – sequence: 5 givenname: Nagendra N surname: Dudi-Venkata fullname: Dudi-Venkata, Nagendra N organization: Discipline of Surgery, Faculty of Health and Medical Science, School of Medicine, University of Adelaide, Adelaide, SA, Australia – sequence: 6 givenname: Hong X surname: Lee fullname: Lee, Hong X organization: Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia – sequence: 7 givenname: Michelle L surname: Thomas fullname: Thomas, Michelle L organization: Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia – sequence: 8 givenname: Jianliang surname: Liu fullname: Liu, Jianliang organization: Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia – sequence: 9 givenname: Maxime J M surname: van der Valk fullname: van der Valk, Maxime J M organization: Department of Surgery, Leiden University Medical Center, Leiden, Netherlands – sequence: 10 givenname: Harm J T surname: Rutten fullname: Rutten, Harm J T organization: GROW, School of Oncology and Developmental Biology, University of Maastricht, Maastricht, Netherlands – sequence: 11 givenname: Geerard L surname: Beets fullname: Beets, Geerard L organization: Department of Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Netherlands – sequence: 12 givenname: Miranda surname: Kusters fullname: Kusters, Miranda organization: Department of Surgery, Amsterdam University Medical Centers, Amsterdam, Netherlands – sequence: 13 givenname: Tarik surname: Sammour fullname: Sammour, Tarik organization: Discipline of Surgery, Faculty of Health and Medical Science, School of Medicine, University of Adelaide, Adelaide, SA, Australia |
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ContentType | Journal Article |
Copyright | Copyright © 2019 Haanappel, Kroon, Schaap, Bedrikovetski, Dudi-Venkata, Lee, Thomas, Liu, van der Valk, Rutten, Beets, Kusters and Sammour. Copyright © 2019 Haanappel, Kroon, Schaap, Bedrikovetski, Dudi-Venkata, Lee, Thomas, Liu, van der Valk, Rutten, Beets, Kusters and Sammour. 2019 Haanappel, Kroon, Schaap, Bedrikovetski, Dudi-Venkata, Lee, Thomas, Liu, van der Valk, Rutten, Beets, Kusters and Sammour |
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Keywords | oncological outcomes neoadjuvant (chemo)radiotherapy lateral lymph nodes locally advanced low rectal cancer survival |
Language | English |
License | Copyright © 2019 Haanappel, Kroon, Schaap, Bedrikovetski, Dudi-Venkata, Lee, Thomas, Liu, van der Valk, Rutten, Beets, Kusters and Sammour. 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. |
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Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 This article was submitted to Surgical Oncology, a section of the journal Frontiers in Oncology Reviewed by: Yoshiharu Sakai, Kyoto University, Japan; Fergal Flemingfergal, Medical Center, University of Rochester, United States Edited by: Des Winter, St. Vincent's University Hospital, Ireland |
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SubjectTerms | lateral lymph nodes locally advanced low rectal cancer neoadjuvant (chemo)radiotherapy oncological outcomes Oncology survival |
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Title | Lateral Lymph Node Metastases in Locally Advanced Low Rectal Cancers May Not Be Treated Effectively With Neoadjuvant (Chemo)Radiotherapy Only |
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