Shu Pei, Ouyang Ganlu, Wang Fang, Zhou Jitao, Shen Yali, Li Zhiping, Wang Xin
Department of Abdominal Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China.
Cancer Manag Res. 2020 Sep 23;12:8913-8921. doi: 10.2147/CMAR.S249248. eCollection 2020.
Retroperitoneal lymph node metastases are rare in colorectal cancer. Optimal treatment strategies are still unknown.
We retrospectively enrolled colorectal cancer patients who had received radiotherapy for retroperitoneal lymph node metastases from 2009 to 2018. Patients with isolated retroperitoneal lymph node metastases or retroperitoneal lymph nodes with extra-retroperitoneal metastases were all included. A median dose of 60 Gy was delivered.
A total of 68 patients were enrolled in this study; 28 (41%) of them had extra-retroperitoneal metastases. In the isolated retroperitoneal lymph node metastases group, complete response was found in 5 patients (12.5%), partial response was achieved in 20 patients (50%), 9 patients (22.5%) had stable disease. The 1-, 2- and 3-year local control rates were 87.5%, 77.5%, and 70%. In the extra-retroperitoneal metastases group, the disease control rate was 75%, including complete response in 1 patient (3.6%), partial response in 4 patients (14.3%) and stable disease in 16 patients (57.1%). The 1-, 2- and 3-year local control rates were 57.1%, 42.8%, and 0%. The median overall survival was 59.4 months and 19 months in the isolated retroperitoneal lymph node metastases group and extra-retroperitoneal metastases group, respectively. In the isolated retroperitoneal lymph node metastases group, the 1-year and 3-year overall survival values were 90.2% and 75.8%, respectively. The 1-year and 3-year progression-free survival values were 57.9% and 0%, respectively. The extra-retroperitoneal metastases group experienced worse survival outcome (1-year overall survival: 57.9%, <0.05; and 1-year progression-free survival: 22.5%, <0.05).
For patients with isolated retroperitoneal lymph node metastases, radiotherapy combined with systemic treatment can be used as a method to achieve no evidence of disease and can result in good local control and survival. For patients with extra-retroperitoneal metastases, although the survival is much worse than that of isolated retroperitoneal lymph node metastases, radiotherapy is an effective palliative treatment to relieve pain and obstruction based on systemic treatment.
结直肠癌患者出现腹膜后淋巴结转移较为罕见。最佳治疗策略仍不明确。
我们回顾性纳入了2009年至2018年期间因腹膜后淋巴结转移接受放疗的结直肠癌患者。纳入了孤立性腹膜后淋巴结转移患者或伴有腹膜后外转移的腹膜后淋巴结患者。中位剂量为60 Gy。
本研究共纳入68例患者；其中28例（41%）伴有腹膜后外转移。在孤立性腹膜后淋巴结转移组中，5例（12.5%）患者达到完全缓解，20例（50%）患者达到部分缓解，9例（22.5%）患者病情稳定。1年、2年和3年的局部控制率分别为87.5%、77.5%和70%。在腹膜后外转移组中，疾病控制率为75%，包括1例（3.6%）患者完全缓解，4例（14.3%）患者部分缓解，16例（57.1%）患者病情稳定。1年、2年和3年的局部控制率分别为57.1%、42.8%和0%。孤立性腹膜后淋巴结转移组和腹膜后外转移组的中位总生存期分别为59.4个月和19个月。在孤立性腹膜后淋巴结转移组中，1年和3年的总生存值分别为90.2%和75.8%。1年和3年的无进展生存值分别为57.9%和0%。腹膜后外转移组的生存结局较差（1年总生存：57.9%，<0.05；1年无进展生存：22.5%，<0.05）。
对于孤立性腹膜后淋巴结转移患者，放疗联合全身治疗可作为实现无疾病证据的一种方法，并且可带来良好的局部控制和生存。对于伴有腹膜后外转移的患者，尽管其生存情况比孤立性腹膜后淋巴结转移患者差得多，但放疗是以全身治疗为基础缓解疼痛和梗阻的一种有效姑息治疗方法。
