Chen Mo, Liu Shuai, Xu Meng, Yi Han-Chen, Liu Yanping, He Fang
Radiotherapy Department of Thorax and Abdomen Carcinoma, Cancer Center, The First People's Hospital of Foshan, Foshan, China.
Department of Radiation Oncology, The Sixth Affiliated Hospital of Sun Yat-Sen University, 26 YuanCun ErHeng Road, Guangzhou, 510655, Guangdong, China.
Discov Oncol. 2021 Dec 4;12(1):59. doi: 10.1007/s12672-021-00455-0.
Some patients with locally advanced rectal cancer (LARC) present with inguinal lymph node metastases without evidence of other systemic disease, known as solitary inguinal lymph node metastasis (SILNM). These patients may represent a distinct subset who have a more favorable prognosis and should be treated with curative intent. The optimal treatment strategy for these patients has not been determined.
We retrospectively reviewed 16 consecutive LARC patients diagnosed between January 2017 and December 2019, who had SILNM, were treated with an inguinal lymph nodes (ILN) radiation boost with curative intent during neoadjuvant chemoradiotherapy (nCRT) and underwent total mesorectal excision (TME). We used Kaplan-Meier survival curves to calculate survival rates, and recorded radiation-related toxicity.
None of these 16 patients developed pelvic or inguinal recurrences, and 3 of the patients developed distant metastases. The 3-year overall survival rate and locoregional relapse-free survival rate were both 100%. The 3-year disease-free rate and distant metastasis-free survival rate were both 81.3%. Of 5 patients who had ILN dissection for suspicious ILNs after neoadjuvant treatment, 2 had residual nodal tumor confirmed. Grade 3 toxicity was found in 5 patients, and no patients had lymphedema or other grade 4 or 5 toxicities.
In LARC patients with synchronous SILNM, a radiation boost to the ILNs during nCRT achieved excellent local control with acceptable toxicity. Though the optimal treatment strategy remains unclear, nCRT with an ILN radiation boost prior to TME may be a reasonable therapeutic approach to consider for this subset of patients.
一些局部晚期直肠癌（LARC）患者出现腹股沟淋巴结转移，而无其他系统性疾病证据，称为孤立性腹股沟淋巴结转移（SILNM）。这些患者可能代表一个预后较好的独特亚组，应接受根治性治疗。这些患者的最佳治疗策略尚未确定。
我们回顾性分析了2017年1月至2019年12月期间连续诊断的16例LARC患者，这些患者有SILNM，在新辅助放化疗（nCRT）期间接受了腹股沟淋巴结（ILN）根治性放疗加强，并接受了全直肠系膜切除术（TME）。我们使用Kaplan-Meier生存曲线计算生存率，并记录放疗相关毒性。
这16例患者均未发生盆腔或腹股沟复发，3例患者发生远处转移。3年总生存率和局部区域无复发生存率均为100%。3年无病生存率和无远处转移生存率均为81.3%。新辅助治疗后对5例可疑ILN进行ILN清扫的患者中，2例证实有残留淋巴结肿瘤。5例患者出现3级毒性，无患者发生淋巴水肿或其他4级或5级毒性。
在同步发生SILNM的LARC患者中，nCRT期间对ILN进行放疗加强可实现良好的局部控制，且毒性可接受。尽管最佳治疗策略仍不明确，但在TME之前进行nCRT联合ILN放疗加强可能是该亚组患者可考虑的合理治疗方法。
