Coverage of Lateral Lymph Nodes in Rectal Cancer Patients with Routine Radiation Therapy Practice and Associated Locoregional Recurrence Rates

医学 放射治疗 结直肠癌 磁共振成像 前列腺癌 癌症 外科 核医学 放射科 内科学
作者
Tania C. Sluckin,Sanne-Marije J.A. Hazen,Karin Horsthuis,Regina G. H. Beets‐Tan,Imogeen E. Antonisse,Maaike Berbée,Liselotte W. van Bockel,Anniek H. Boer,Heleen M. Ceha,Jeltsje S. Cnossen,Elisabeth D. Geijsen,M.D. den Hartogh,Ellen M. Hendriksen,Martijn Intven,Mathilde M. Leseman-Hoogenboom,Philip Meijnen,Karin Müller,Vera Oppedijk,Tom Rozema,Heidi Rütten,Patty H. Spruit,Tanja C. Stam,Laura A. Velema,An-Sofie Verrijssen,Johanna Vos-Westerman,Pieter J. Tanis,Corrie A.M. Marijnen,Miranda Kusters
出处
期刊:International Journal of Radiation Oncology Biology Physics [Elsevier BV]
卷期号:117 (2): 422-433 被引量:3
标识
DOI:10.1016/j.ijrobp.2023.04.013
摘要

Involved internal iliac and obturator lateral lymph nodes (LLNs) are a known risk factor for the occurrence of ipsilateral local recurrences (LLR) in rectal cancer. This study examined coverage of LLNs with routine radiation therapy practice in the Netherlands and associated LLR rates.Patients with a primary tumor ≤8 cm of the anorectal junction, cT3-4 stage, and at least 1 internal iliac or obturator LLN with short axis ≥5 mm who received neoadjuvant (chemo)radiation therapy, were selected from a national, cross-sectional study of patients with rectal cancer treated in the Netherlands in 2016. Magnetic resonance images and radiation therapy treatment plans were reviewed regarding segmented LLNs as gross tumor volume (GTV), location of LLNs within clinical target volume (CTV), and received proportion of the planned radiation therapy dose.A total of 223 out of 3057 patients with at least 1 LLN ≥5 mm were selected. Of those, 180 (80.7%) LLNs were inside the CTV, of which 60 (33.3%) were segmented as GTV. Overall, 202 LLNs (90.6%) received ≥95% of the planned dose. Four-year LLR rates were not significantly higher for LLNs situated outside the CTV compared with those inside (4.0% vs 12.5%, P = .092) or when receiving <95% versus ≥95% of the planned radiation therapy dose (7.1% vs 11.3%, P = .843), respectively. Two of 7 patients who received a dose escalation of 60 Gy developed an LLR (4-year LLR rate of 28.6%).This evaluation of routine radiation therapy practice showed that adequate coverage of LLNs was still associated with considerable 4-year LLR rates. Techniques resulting in better local control for patients with involved LLNs need to be explored further.
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