Neoadjuvant (chemo)radiotherapy with total mesorectal excision only is not sufficient to prevent lateral local recurrence in enlarged nodes: Results of the multicenter lateral node study of patients with low ct3/4 rectal cancer

the Lateral Node Study Consortium

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

PURPOSE Improvements in magnetic resonance imaging (MRI), total mesorectal excision (TME) surgery, and the use of (chemo)radiotherapy ([C]RT) have improved local control of rectal cancer; however, we have been unable to eradicate local recurrence (LR). Even in the face of TME and negative resection margins (R0), a significant proportion of patients with enlarged lateral lymph nodes (LLNs) suffer from lateral LR (LLR). Japanese studies suggest that the addition of an LLN dissection (LLND) could reduce LLR. This multicenter pooled analysis aims to ascertain whether LLNs actually pose a problem and whether LLND results in fewer LLRs. PATIENTS AND METHODS Data from 1,216 consecutive patients with cT3/T4 rectal cancers up to 8 cm from the anal verge who underwent surgery in a 5-year period were collected. LLND was performed in 142 patients (12%). MRIs were re-evaluated with a standardized protocol to assess LLN features. RESULTS On pretreatment MRI, 703 patients (58%) had visible LLN, and 192 (16%) had a short axis of at least 7 mm. One hundred eight patients developed LR (5-year LR rate, 10.0%), of which 59 (54%) were LLRs (5-year LLR rate, 5.5%). After multivariable analyses, LLNs with a short axis of at least 7 mm resulted in a significantly higher risk of LLR (hazard ratio, 2.060; P = .045) compared with LLNs of less than 7 mm. In patients with LLNs at least 7 mm, (C)RT plus TME plus LLND resulted in a 5-year LLR of 5.7%, which was significantly lower than that in patients who underwent (C)RT plus TME (5-year LLR, 19.5%; P = .042). CONCLUSION LLR is still a significant problem after (C)RT plus TME in LLNs with a short axis at least 7 mm on pretreatment MRI. The addition of LLND results in a significantly lower LLR rate.
Original languageEnglish
Pages (from-to)33-43
JournalJournal of Clinical Oncology
Volume37
Issue number1
DOIs
Publication statusPublished - 2019

Cite this

@article{0a67499f178a4e629ae4e1dc94d89f67,
title = "Neoadjuvant (chemo)radiotherapy with total mesorectal excision only is not sufficient to prevent lateral local recurrence in enlarged nodes: Results of the multicenter lateral node study of patients with low ct3/4 rectal cancer",
abstract = "PURPOSE Improvements in magnetic resonance imaging (MRI), total mesorectal excision (TME) surgery, and the use of (chemo)radiotherapy ([C]RT) have improved local control of rectal cancer; however, we have been unable to eradicate local recurrence (LR). Even in the face of TME and negative resection margins (R0), a significant proportion of patients with enlarged lateral lymph nodes (LLNs) suffer from lateral LR (LLR). Japanese studies suggest that the addition of an LLN dissection (LLND) could reduce LLR. This multicenter pooled analysis aims to ascertain whether LLNs actually pose a problem and whether LLND results in fewer LLRs. PATIENTS AND METHODS Data from 1,216 consecutive patients with cT3/T4 rectal cancers up to 8 cm from the anal verge who underwent surgery in a 5-year period were collected. LLND was performed in 142 patients (12{\%}). MRIs were re-evaluated with a standardized protocol to assess LLN features. RESULTS On pretreatment MRI, 703 patients (58{\%}) had visible LLN, and 192 (16{\%}) had a short axis of at least 7 mm. One hundred eight patients developed LR (5-year LR rate, 10.0{\%}), of which 59 (54{\%}) were LLRs (5-year LLR rate, 5.5{\%}). After multivariable analyses, LLNs with a short axis of at least 7 mm resulted in a significantly higher risk of LLR (hazard ratio, 2.060; P = .045) compared with LLNs of less than 7 mm. In patients with LLNs at least 7 mm, (C)RT plus TME plus LLND resulted in a 5-year LLR of 5.7{\%}, which was significantly lower than that in patients who underwent (C)RT plus TME (5-year LLR, 19.5{\%}; P = .042). CONCLUSION LLR is still a significant problem after (C)RT plus TME in LLNs with a short axis at least 7 mm on pretreatment MRI. The addition of LLND results in a significantly lower LLR rate.",
author = "{the Lateral Node Study Consortium} and Atsushi Ogura and Tsuyoshi Konishi and Chris Cunningham and Julio Garcia-Aguilar and Henrik Iversen and Shigeo Toda and Lee, {In Kyu} and Lee, {Hong Xiang} and Keisuke Uehara and Peter Lee and Hein Putter and {van de Velde}, {Cornelis J. H.} and Beets, {Geerard L.} and Rutten, {Harm J. T.} and Miranda Kusters and Aalbers, {A. G. J.} and T. Aiba and T. Akiyoshi and Beets-Tan, {R. G. H.} and M. Betts and Blazic, {I. M.} and Brown, {K. G.} and N. Campbell and Choi, {M. H.} and Gollub, {M. J.} and Y. Hanaoka and Kim, {M. K.} and E. Meershoek-Klein-Kranenbarg and H. Kuroyanagi and M. Maas and A. Martling and J. Moore and Nieuwenhuijzen, {G. A.} and Oh, {S. N.} and S. Roodbeen and T. Sammour and D. Schaap and Solomon, {M. J.} and M. Thomas and K. Tomizawa and {van der Sande}, {M. E.} and C. Suzuki and {van der Valk}, {M. J. M.} and T. Wells and Won, {D. D.}",
year = "2019",
doi = "10.1200/JCO.18.00032",
language = "English",
volume = "37",
pages = "33--43",
journal = "Journal of Clinical Oncology",
issn = "0732-183X",
publisher = "American Society of Clinical Oncology",
number = "1",

}

TY - JOUR

T1 - Neoadjuvant (chemo)radiotherapy with total mesorectal excision only is not sufficient to prevent lateral local recurrence in enlarged nodes: Results of the multicenter lateral node study of patients with low ct3/4 rectal cancer

AU - the Lateral Node Study Consortium

AU - Ogura, Atsushi

AU - Konishi, Tsuyoshi

AU - Cunningham, Chris

AU - Garcia-Aguilar, Julio

AU - Iversen, Henrik

AU - Toda, Shigeo

AU - Lee, In Kyu

AU - Lee, Hong Xiang

AU - Uehara, Keisuke

AU - Lee, Peter

AU - Putter, Hein

AU - van de Velde, Cornelis J. H.

AU - Beets, Geerard L.

AU - Rutten, Harm J. T.

AU - Kusters, Miranda

AU - Aalbers, A. G. J.

AU - Aiba, T.

AU - Akiyoshi, T.

AU - Beets-Tan, R. G. H.

AU - Betts, M.

AU - Blazic, I. M.

AU - Brown, K. G.

AU - Campbell, N.

AU - Choi, M. H.

AU - Gollub, M. J.

AU - Hanaoka, Y.

AU - Kim, M. K.

AU - Meershoek-Klein-Kranenbarg, E.

AU - Kuroyanagi, H.

AU - Maas, M.

AU - Martling, A.

AU - Moore, J.

AU - Nieuwenhuijzen, G. A.

AU - Oh, S. N.

AU - Roodbeen, S.

AU - Sammour, T.

AU - Schaap, D.

AU - Solomon, M. J.

AU - Thomas, M.

AU - Tomizawa, K.

AU - van der Sande, M. E.

AU - Suzuki, C.

AU - van der Valk, M. J. M.

AU - Wells, T.

AU - Won, D. D.

PY - 2019

Y1 - 2019

N2 - PURPOSE Improvements in magnetic resonance imaging (MRI), total mesorectal excision (TME) surgery, and the use of (chemo)radiotherapy ([C]RT) have improved local control of rectal cancer; however, we have been unable to eradicate local recurrence (LR). Even in the face of TME and negative resection margins (R0), a significant proportion of patients with enlarged lateral lymph nodes (LLNs) suffer from lateral LR (LLR). Japanese studies suggest that the addition of an LLN dissection (LLND) could reduce LLR. This multicenter pooled analysis aims to ascertain whether LLNs actually pose a problem and whether LLND results in fewer LLRs. PATIENTS AND METHODS Data from 1,216 consecutive patients with cT3/T4 rectal cancers up to 8 cm from the anal verge who underwent surgery in a 5-year period were collected. LLND was performed in 142 patients (12%). MRIs were re-evaluated with a standardized protocol to assess LLN features. RESULTS On pretreatment MRI, 703 patients (58%) had visible LLN, and 192 (16%) had a short axis of at least 7 mm. One hundred eight patients developed LR (5-year LR rate, 10.0%), of which 59 (54%) were LLRs (5-year LLR rate, 5.5%). After multivariable analyses, LLNs with a short axis of at least 7 mm resulted in a significantly higher risk of LLR (hazard ratio, 2.060; P = .045) compared with LLNs of less than 7 mm. In patients with LLNs at least 7 mm, (C)RT plus TME plus LLND resulted in a 5-year LLR of 5.7%, which was significantly lower than that in patients who underwent (C)RT plus TME (5-year LLR, 19.5%; P = .042). CONCLUSION LLR is still a significant problem after (C)RT plus TME in LLNs with a short axis at least 7 mm on pretreatment MRI. The addition of LLND results in a significantly lower LLR rate.

AB - PURPOSE Improvements in magnetic resonance imaging (MRI), total mesorectal excision (TME) surgery, and the use of (chemo)radiotherapy ([C]RT) have improved local control of rectal cancer; however, we have been unable to eradicate local recurrence (LR). Even in the face of TME and negative resection margins (R0), a significant proportion of patients with enlarged lateral lymph nodes (LLNs) suffer from lateral LR (LLR). Japanese studies suggest that the addition of an LLN dissection (LLND) could reduce LLR. This multicenter pooled analysis aims to ascertain whether LLNs actually pose a problem and whether LLND results in fewer LLRs. PATIENTS AND METHODS Data from 1,216 consecutive patients with cT3/T4 rectal cancers up to 8 cm from the anal verge who underwent surgery in a 5-year period were collected. LLND was performed in 142 patients (12%). MRIs were re-evaluated with a standardized protocol to assess LLN features. RESULTS On pretreatment MRI, 703 patients (58%) had visible LLN, and 192 (16%) had a short axis of at least 7 mm. One hundred eight patients developed LR (5-year LR rate, 10.0%), of which 59 (54%) were LLRs (5-year LLR rate, 5.5%). After multivariable analyses, LLNs with a short axis of at least 7 mm resulted in a significantly higher risk of LLR (hazard ratio, 2.060; P = .045) compared with LLNs of less than 7 mm. In patients with LLNs at least 7 mm, (C)RT plus TME plus LLND resulted in a 5-year LLR of 5.7%, which was significantly lower than that in patients who underwent (C)RT plus TME (5-year LLR, 19.5%; P = .042). CONCLUSION LLR is still a significant problem after (C)RT plus TME in LLNs with a short axis at least 7 mm on pretreatment MRI. The addition of LLND results in a significantly lower LLR rate.

UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85059232186&origin=inward

UR - https://www.ncbi.nlm.nih.gov/pubmed/30403572

U2 - 10.1200/JCO.18.00032

DO - 10.1200/JCO.18.00032

M3 - Article

VL - 37

SP - 33

EP - 43

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

SN - 0732-183X

IS - 1

ER -