Advertisement

Annals of Surgical Oncology

, Volume 22, Issue 5, pp 1520–1526 | Cite as

Incorporation of Radiotherapy in the Multidisciplinary Treatment of Isolated Retroperitoneal Lymph Node Recurrence from Colorectal Cancer

  • Jeongshim Lee
  • Jee Suk Chang
  • Sang Joon Shin
  • Joon Seok Lim
  • Ki Chang Keum
  • Nam Kyu Kim
  • Joong Bae Ahn
  • Tae Il Kim
  • Woong Sub KoomEmail author
Colorectal Cancer

Abstract

Purpose

This article was designed to study the clinical outcomes and prognostic factors following radiotherapy (RT) in the multidisciplinary management of isolated retroperitoneal lymph node (RPLN) recurrence of colorectal cancer.

Methods

We identified 52 patients treated consecutively with tumor-directed RT for isolated RPLN recurrence. Twenty-five patients received upfront RT (Group 1). Twenty-seven patients received RT after systemic therapy. The deferred RT was administered either to locally controlled tumors (Group 2, n = 17) or to locally progressive tumors in RPLNs (Group 3, n = 10).

Results

The median overall survival and progression-free survival were 41 and 13 months, respectively, with a median follow-up time of 34 months. Survival was not significantly different among three groups. Local recurrence (32/52) was predominant and occurred earlier than distant metastasis (31/52). Two-thirds of the local recurrences (21/32) involved outfield recurrence, which was mostly in the cranial direction (15/21) from the upper margin of the RT volume. Repeated RT successfully salvaged a substantial number of patients. A shorter disease-free interval, low-dose radiation, and a tumor location above the renal vein were independent risk factors for local recurrence (all P < 0.05). A large gross tumor volume was an independent risk factor for distant metastasis (P = 0.037). No acute or late RT-related toxicity ≥ grade 3 occurred.

Conclusions

Our analysis suggests that both upfront RT and deferred RT incorporated into multidisciplinary management are potentially effective treatment strategies. We found that gross tumor volume, tumor location, and disease-free interval are important prognostic factors and should be taken into consideration to decide the timing of RT.

Keywords

Overall Survival Renal Vein Clinical Target Volume Gross Tumor Volume Helical Tomotherapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Conflict of interest

None.

Supplementary material

10434_2014_4363_MOESM1_ESM.doc (98 kb)
Supplementary material 1 (DOC 98 kb)

References

  1. 1.
    Salo JC, Paty PB, Guillem J, Minsky BD, Harrison LB, Cohen AM. Surgical salvage of recurrent rectal carcinoma after curative resection: a 10-year experience. Ann Surg Oncol. 1999;6:171–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Ho TW, Mack LA, Temple WJ. Operative salvage for retroperitoneal nodal recurrence in colorectal cancer: a systematic review. Ann Surg Oncol. 2011;18:697–703.CrossRefPubMedGoogle Scholar
  3. 3.
    Kelly H, Goldberg RM. Systemic therapy for metastatic colorectal cancer: current options, current evidence. J Clin Oncol. 2005;23:4553–60.CrossRefPubMedGoogle Scholar
  4. 4.
    Shibata D, Paty PB, Guillem JG, Wong WD, Cohen AM. Surgical management of isolated retroperitoneal recurrences of colorectal carcinoma. Dis Colon Rectum. 2002;45:795–801.CrossRefPubMedGoogle Scholar
  5. 5.
    Min BS, Kim NK, Sohn SK, Cho CH, Lee KY, Baik SH. Isolated paraaortic lymph-node recurrence after the curative resection of colorectal carcinoma. J Surg Oncol. 2008;97:136–40.CrossRefPubMedGoogle Scholar
  6. 6.
    Dumont F, Kothodinis K, Goere D, et al. Central retroperitoneal recurrences from colorectal cancer: are lymph node and locoregional recurrences the same disease? Eur J Surg Oncol. 2012;38:611–6.CrossRefPubMedGoogle Scholar
  7. 7.
    van de Velde CJ, Boelens PG, Tanis PJ, et al. Experts reviews of the multidisciplinary consensus conference colon and rectal cancer 2012: science, opinions and experiences from the experts of surgery. Eur J Surg Oncol. 2014;40:454–68.CrossRefPubMedGoogle Scholar
  8. 8.
    Yeo SG, Kim DY, Kim TH, et al. Curative chemoradiotherapy for isolated retroperitoneal lymph node recurrence of colorectal cancer. Radiother Oncol. 2010;97:307–11.CrossRefPubMedGoogle Scholar
  9. 9.
    Sobhani I, Tiret E, Lebtahi R, et al. Early detection of recurrence by 18FDG-PET in the follow-up of patients with colorectal cancer. Br J Cancer. 2008;98:875–80.CrossRefPubMedCentralPubMedGoogle Scholar
  10. 10.
    Bradley JD, Ieumwananonthachai N, Purdy JA, et al. Gross tumor volume, critical prognostic factor in patients treated with three-dimensional conformal radiation therapy for non-small-cell lung carcinoma. Int J Radiat Oncol Biol Phys. 2002;52:49–57.CrossRefPubMedGoogle Scholar
  11. 11.
    Romesser PB, Qureshi MM, Subramaniam RM, Sakai O, Jalisi S, Truong MT. A prognostic volumetric threshold of gross tumor volume in head and neck cancer patients treated with radiotherapy. Am J Clin Oncol. 2014;37:154–61.CrossRefPubMedGoogle Scholar
  12. 12.
    Choi CW, Cho CK, Yoo SY, et al. Image-guided stereotactic body radiation therapy in patients with isolated para-aortic lymph node metastases from uterine cervical and corpus cancer. Int J Radiat Oncol Biol Phys. 2009;74:147–53.CrossRefPubMedGoogle Scholar
  13. 13.
    Milano MT, Philip A, Okunieff P. Analysis of patients with oligometastases undergoing two or more curative-intent stereotactic radiotherapy courses. Int J Radiat Oncol Biol Phys. 2009;73:832–7.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Jeongshim Lee
    • 1
  • Jee Suk Chang
    • 1
  • Sang Joon Shin
    • 2
  • Joon Seok Lim
    • 3
  • Ki Chang Keum
    • 1
  • Nam Kyu Kim
    • 4
  • Joong Bae Ahn
    • 2
  • Tae Il Kim
    • 2
  • Woong Sub Koom
    • 1
    Email author
  1. 1.Department of Radiation Oncology, Yonsei Cancer CenterYonsei University College of MedicineSeoulRepublic of Korea
  2. 2.Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
  3. 3.Department of RadiologyYonsei University College of MedicineSeoulRepublic of Korea
  4. 4.Department of SurgeryYonsei University College of MedicineSeoulRepublic of Korea

Personalised recommendations