Coverage of Lateral Lymph Nodes in Rectal Cancer Patients with Routine Radiation Therapy Practice and Associated Locoregional Recurrence Rates
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...
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| Veröffentlicht in: | International journal of radiation oncology, biology, physics biology, physics, 2023-10, Vol.117 (2), p.422-433 |
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| creator | Sluckin, Tania C. Hazen, Sanne-Marije J.A. Horsthuis, Karin Beets-Tan, Regina G.H. Antonisse, Imogeen E. Berbée, Maaike van Bockel, Liselotte W. Boer, Anniek H. Ceha, Heleen M. Cnossen, Jeltsje S. Geijsen, Elisabeth D. den Hartogh, Mariska D. Hendriksen, Ellen M. Intven, Martijn P.W. Leseman-Hoogenboom, Mathilde M. Meijnen, Philip Muller, Karin Oppedijk, Vera Rozema, Tom Rütten, Heidi Spruit, Patty H. Stam, Tanja C. Velema, Laura A. Verrijssen, An-Sofie E. Vos-Westerman, Johanna Tanis, Pieter J. Marijnen, Corrie A.M. Kusters, Miranda |
| description | 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 |
| doi_str_mv | 10.1016/j.ijrobp.2023.04.013 |
| format | Article |
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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.</description><identifier>ISSN: 0360-3016</identifier><identifier>EISSN: 1879-355X</identifier><identifier>DOI: 10.1016/j.ijrobp.2023.04.013</identifier><identifier>PMID: 37120027</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><ispartof>International journal of radiation oncology, biology, physics, 2023-10, Vol.117 (2), p.422-433</ispartof><rights>2023 Elsevier Inc.</rights><rights>Copyright © 2023 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c362t-e853651ab7714e113cd9a7f5abc99eb5c8f0c42944adb6946441eb91db968f113</citedby><cites>FETCH-LOGICAL-c362t-e853651ab7714e113cd9a7f5abc99eb5c8f0c42944adb6946441eb91db968f113</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ijrobp.2023.04.013$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,45976</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37120027$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sluckin, Tania C.</creatorcontrib><creatorcontrib>Hazen, Sanne-Marije J.A.</creatorcontrib><creatorcontrib>Horsthuis, Karin</creatorcontrib><creatorcontrib>Beets-Tan, Regina G.H.</creatorcontrib><creatorcontrib>Antonisse, Imogeen E.</creatorcontrib><creatorcontrib>Berbée, Maaike</creatorcontrib><creatorcontrib>van Bockel, Liselotte W.</creatorcontrib><creatorcontrib>Boer, Anniek H.</creatorcontrib><creatorcontrib>Ceha, Heleen M.</creatorcontrib><creatorcontrib>Cnossen, Jeltsje S.</creatorcontrib><creatorcontrib>Geijsen, Elisabeth D.</creatorcontrib><creatorcontrib>den Hartogh, Mariska D.</creatorcontrib><creatorcontrib>Hendriksen, Ellen M.</creatorcontrib><creatorcontrib>Intven, Martijn P.W.</creatorcontrib><creatorcontrib>Leseman-Hoogenboom, Mathilde M.</creatorcontrib><creatorcontrib>Meijnen, Philip</creatorcontrib><creatorcontrib>Muller, Karin</creatorcontrib><creatorcontrib>Oppedijk, Vera</creatorcontrib><creatorcontrib>Rozema, Tom</creatorcontrib><creatorcontrib>Rütten, Heidi</creatorcontrib><creatorcontrib>Spruit, Patty H.</creatorcontrib><creatorcontrib>Stam, Tanja C.</creatorcontrib><creatorcontrib>Velema, Laura A.</creatorcontrib><creatorcontrib>Verrijssen, An-Sofie E.</creatorcontrib><creatorcontrib>Vos-Westerman, Johanna</creatorcontrib><creatorcontrib>Tanis, Pieter J.</creatorcontrib><creatorcontrib>Marijnen, Corrie A.M.</creatorcontrib><creatorcontrib>Kusters, Miranda</creatorcontrib><creatorcontrib>Dutch Snapshot Research Group</creatorcontrib><title>Coverage of Lateral Lymph Nodes in Rectal Cancer Patients with Routine Radiation Therapy Practice and Associated Locoregional Recurrence Rates</title><title>International journal of radiation oncology, biology, physics</title><addtitle>Int J Radiat Oncol Biol Phys</addtitle><description>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. 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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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>37120027</pmid><doi>10.1016/j.ijrobp.2023.04.013</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record> |
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| title | Coverage of Lateral Lymph Nodes in Rectal Cancer Patients with Routine Radiation Therapy Practice and Associated Locoregional Recurrence Rates |
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