Neoadjuvant Chemoradiotherapy Affects the Indications for Lateral Pelvic Node Dissection in Mid/Low Rectal Cancer with Clinically Suspected Lateral Node Involvement: A Multicenter Retrospective Cohort Study

Oh, Heung Kwon; Kang, Sung Bum; Lee, Sung Min; Lee, Soo Young; Ihn, Myoung Hun; Kim, Duck Woo; Park, Ji Hoon; Kim, Young Hoon; Lee, Kyung Ho; Kim, Jae Sung; Kim, Jin Won; Kim, Jee Hyun; Chang, Tae Young; Park, Sung Chan; Sohn, Dae Kyung; Oh, Jae Hwan; Park, Ji Won; Ryoo, Seung Bum; Jeong, Seung Yong; Park, Kyu Joo

doi:10.1245/s10434-014-3559-z

Cited by 96 publications

(94 citation statements)

References 34 publications

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“…Because patients with locally advanced lower rectal cancer developed lung metastases at twice the rate of liver metastases following surgery, careful screening for lung metastasis should be considered during follow-up surveillance. Most LPNs in our patients were downsized by administering CRT regardless of the presence of metastasis, as was the case in previous studies [15,16]. Neoadjuvant CRT has been shown to reduce the number of harvested mesorectal lymph nodes during pathological assessment [17], and this phenomenon was previously reported to be caused by lymphocyte depletion, atrophy of the stroma, and replacement by adipocytes [18].…”

Section: Discussionsupporting

confidence: 72%

“…Oh et al [16] investigated 66 patients with mid/low rectal cancer who had suspected LPN metastases and who underwent preoperative CRT and LPN dissection; they found that the overall and disease-free survival rates of patients with persistently enlarged LPNs after CRT were poorer. In contrast, Akiyoshi et al [11] reported no association between LPN size and prognosis after analyzing 77 patients with low rectal cancer.…”

Section: Discussionmentioning

confidence: 99%

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Correlations between the Recurrence Patterns and Sizes of Lateral Pelvic Lymph Nodes before and after Chemoradiotherapy in Patients with Lower Rectal Cancer

et al. 2018

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Objective: Factors that predict rectal cancer metastasis to the lungs remain undefined. We investigated whether the lateral pelvic lymph node (LPN) sizes before and after chemoradiotherapy (CRT) correlate with lung metastasis after surgery for lower rectal cancer. Methods: Two hundred and forty patients with lower rectal cancer who received preoperative CRT and curative surgery between 2003 and 2017 were examined. Computed tomography-measured LPN sizes before and after CRT were retrospectively determined by 1 colorectal surgeon who was blinded to the patients’ clinical and pathological outcomes. Results: The 5-year cumulative lung metastasis rates were 15.2%. The mean LPN sizes in patients who developed lung metastasis were larger than those in patients who did not (pre-CRT: 8.7 vs. 6.3 mm, p = 0.003; post-CRT: 6.8 vs. 4.5 mm, p = 0.001). The cumulative lung metastasis rate in patients with large LPNs was higher than in those with small LPNs both before and after CRT. On multivariate analysis, lung metastasis was independently correlated with the LPN size only after CRT (hazard ratio [HR]: 5.58), together with the ypT stage (HR: 2.96) and the tumor location (HR: 0.38). Conclusions: LPN size after CRT is strongly predictive of postoperative lung metastasis in patients with lower rectal cancer.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Correlations between the Recurrence Patterns and Sizes of Lateral Pelvic Lymph Nodes before and after Chemoradiotherapy in Patients with Lower Rectal Cancer

et al. 2018

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“…Several studies have shown that nodal responses tend to mirror the response of the primary tumor, with ypN + rates ≤ 5% in patients with ypT0 disease . Lymph node size, morphology, or both, typically based on MRI, appear to correlate with residual metastases . The reported accuracy of MRI in assessing complete response in initially involved lymph nodes ranges from 80% to 90%, with additional techniques such as contrast enhancement potentially improving these rates .…”

Section: Introductionmentioning

confidence: 99%

Nonoperative management of rectal cancer

Torok

Palta

Willett

et al. 2015

Cancer

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Surgery has long been the primary curative modality for localized rectal cancer. Neoadjuvant chemoradiation has significantly improved local control rates and, in a significant minority, eradicated all disease. Patients who achieve a pathologic complete response to neoadjuvant therapy have an excellent prognosis, although the combination treatment is associated with long-term morbidity. Because of this, a nonoperative management (NOM) strategy has been pursued to preserve sphincter function in select patients. Clinical and radiographic findings are used to identify patients achieving a clinical complete response to chemoradiation, and they are then followed with intensive surveillance. Incomplete, nonresponding and those demonstrating local progression are referred for salvage with standard surgery. Habr-Gama and colleagues have published extensively on this treatment strategy and have laid the groundwork for this approach. This watch-and-wait strategy has evolved over time, and several groups have now reported their results, including recent prospective experiences. Although initial results appear promising, several significant challenges remain for NOM of rectal cancer. Further study is warranted before routine implementation in the clinic. Cancer 2016;122:34-41. V C 2015 American Cancer Society.KEYWORDS: neoadjuvant therapy, nonoperative, radiation therapy, rectal cancer, watchful waiting. INTRODUCTIONIn 2015, an estimated 40,000 cases of rectal cancer will be diagnosed in the United States.1 Surgical therapy, by either low anterior resection (LAR) or abdominoperineal resection (APR), has long been considered the primary curative modality for localized disease. In recent decades, a paradigm shift for locally advanced disease has occurred: postoperative chemoradiation therapy (CRT) has largely been supplanted by a neoadjuvant approach, either through short-course radiation therapy (RT) alone or long-course CRT. This shift has been paralleled by improvements in preoperative imaging and staging, including endoscopic ultrasound (EUS) and magnetic resonance imaging (MRI), as well as advancements in surgical techniques. Although the initial rationale for neoadjuvant treatment was to decrease local recurrence rates, improve treatment tolerability, and increase sphincter-preserving surgery rates, a small but significant percentage of patients were found to be complete pathologic responders upon examination of the surgical specimen. Investigators have since explored definitive CRT and careful follow up, also called nonoperative management (NOM), as a curative approach for select patients, with surgery reserved as salvage therapy. This review aims to critically evaluate NOM of rectal cancer in the modern era. BACKGROUNDThe preferred surgical approach for rectal cancer depends on the location of the cancer in relation to the anal sphincter complex: a sphincter-preserving LAR is reserved for proximal and midrectal lesions, and an APR requiring a permanent stoma is reserved for distal lesions. Both types of resections now...

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“…This study showed that the posttreatment stage is more useful for accurately predicting the outcomes than the clinical stage. In addition, reports from Korea have suggested that the decision to perform lateral lymph node dissection should be based on the lateral lymph node response to CRT 65) . In contrast, Akiyoshi et al showed that MRI before CRT was useful in predicting lateral lymph node metastasis and determining the indications for lateral lymphadenectomy 22) .…”

Section: D the Usefulness Of Lateral Lymph Node Dissection Followinmentioning

confidence: 99%

A review of preoperative chemoradiotherapy for lower rectal cancer

Beppu

Yanagi

Tomita

2017

J Anus Rectum Colon

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Abstract:In Western countries, rectal cancer has been treated by chemoradiotherapy (CRT) for several decades now, and good local control has been reported. However, Japanese guidelines did not strongly recommend CRT, because CRT is only useful for achieving local control and imbues no survival benefit. For this reason, CRT was rarely used to treat rectal cancer in Japan. However, in the 2000s, several studies involving CRT began to be reported from Western countries, such as "correlation between pathological complete response and survival," "induction chemotherapy followed by CRT," and "watch-and-wait policies." These studies were directly correlated with survival of and benefits to the patients. Given these findings, Japanese institutions have recently begun to introduce CRT for rectal cancer. Therefore, in the present study, we reviewed several topics regarding CRT for rectal cancer.

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Neoadjuvant Chemoradiotherapy Affects the Indications for Lateral Pelvic Node Dissection in Mid/Low Rectal Cancer with Clinically Suspected Lateral Node Involvement: A Multicenter Retrospective Cohort Study

Abstract: In mid/low rectal cancer with clinically metastatic LPNs, the decision to perform LPND should be based on the LPN response to nCRT.

Cited by 96 publications

References 34 publications

Correlations between the Recurrence Patterns and Sizes of Lateral Pelvic Lymph Nodes before and after Chemoradiotherapy in Patients with Lower Rectal Cancer

Correlations between the Recurrence Patterns and Sizes of Lateral Pelvic Lymph Nodes before and after Chemoradiotherapy in Patients with Lower Rectal Cancer

Nonoperative management of rectal cancer

A review of preoperative chemoradiotherapy for lower rectal cancer

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