Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, People's Republic of China.
Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Fuzhou, People's Republic of China.
BMC Cancer. 2022 Jun 14;22(1):657. doi: 10.1186/s12885-022-09724-9.
We aimed to explore the necessity of the external iliac lymph nodes (EIN) along with inguinal nodes (IN) region in clinical target volume (CTV) for rectal carcinomas covering the anal canal region.
This research premise enrolled 399 patients who had primary low rectal cancer detected below the peritoneal reflection via magnetic resonance imaging (MRI) and were treated with neoadjuvant radiotherapy (NRT), without elective EIN along with IN irradiation. We stratified the patients into two groups based on whether the lower edge of the rectal tumor extended to the anal canal (P group, n = 109) or not (Rb group, n = 290). Comparison of overall survival (OS), locoregional recurrence-free survival (LRFS), disease-free survival (DFS), as well as distant metastasis-free survival (DMFS) were performed via inverse probability of treatment weighting (IPTW) along with multivariable analyses. We compared the EIN and IN failure rates between the two groups via the Fisher and Gray's test.
P group showed a similar adjusted proportion along with five-year cumulative rate of EIN failure compared with the Rb group. The adjusted proportion and five-year cumulative rate of IN failure in the P group was higher in comparison to the Rb group. There were no remarkable differences in the adjusted five-year OS, DFS, DMFS or LRFS between the two groups. Anal canal involvement (ACI) exhibited no effect on OS, LRFS, DFS, or DMFS.
During NRT for rectal cancer with ACI, it may be possible to exclude the EIN and IN from the CTV.
我们旨在探讨对于覆盖肛管区域的直肠下段癌，在临床靶区（CTV）中是否需要包括髂外淋巴结（EIN）和腹股沟淋巴结（IN）区域。
本研究共纳入 399 例经磁共振成像（MRI）检查发现腹膜反射以下原发性低位直肠癌患者，这些患者均接受新辅助放疗（NRT），但不进行 EIN 和 IN 的选择性照射。我们根据直肠肿瘤下缘是否延伸至肛管将患者分为两组：P 组（n=109）和 Rb 组（n=290）。通过逆概率治疗加权（IPTW）和多变量分析比较两组的总生存率（OS）、局部区域无复发生存率（LRFS）、无病生存率（DFS）和无远处转移生存率（DMFS）。通过 Fisher 和 Gray 检验比较两组的 EIN 和 IN 失败率。
P 组与 Rb 组相比，EIN 失败的调整比例和五年累积率相似。与 Rb 组相比，P 组 IN 失败的调整比例和五年累积率更高。两组的调整五年 OS、DFS、DMFS 或 LRFS 无显著差异。肛管侵犯（ACI）对 OS、LRFS、DFS 或 DMFS 无影响。
对于有 ACI 的直肠癌患者，在接受 NRT 时，可能可以将 EIN 和 IN 排除在 CTV 之外。
