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Lateral Pelvic Nodal Management and Patterns of Failure in Patients Receiving Short-Course Radiation for Locally
Comron Hassanzadeh1, Kasim Mirza2, Bita Kalaghchi3
1Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Diseases of the Colon and Rectum
|October 3, 2023
Summary
Management of lateral pelvic nodes in rectal cancer is controversial. A novel approach using simultaneous integrated boost (SIB) for suspicious lateral nodes in short-course radiation therapy demonstrated safe and effective locoregional control, improving outcomes for node-positive patients.
Area of Science:
- Oncology
- Radiation Oncology
- Colorectal Surgery
Background:
- Management of lateral pelvic lymph nodes in locally advanced rectal cancer (LARC) remains controversial, with limited data on optimal approaches, especially in the context of short-course radiation and nonoperative intent.
- Current strategies lack defined protocols for addressing suspicious lateral pelvic lymph nodes in LARC patients undergoing neoadjuvant therapy.
Discussion:
- A retrospective analysis of 121 LARC patients treated with short-course radiation and consolidation chemotherapy evaluated a simultaneous integrated boost (SIB) to suspicious lateral nodes.
- The study assessed patterns of failure and survival outcomes, comparing patients with and without positive lateral nodes, and analyzing the impact of nodal boost.
- The approach involved biopsy-proven primary tumors staged with pelvic MRI, with a subset receiving SIB (35 Gy in 5 fractions) followed by modified FOLFOX chemotherapy.
Key Insights:
- Lateral node-positive LARC is associated with significantly worse progression-free survival (PFS) and a trend toward worse overall survival (OS).
- The simultaneous integrated boost (SIB) to clinically positive lateral nodes resulted in meaningful locoregional control.
- Nodal boost did not increase acute or late gastrointestinal (GI) toxicity, indicating a safe application in this patient cohort.
Outlook:
- The findings suggest that SIB to suspicious lateral nodes is a safe and effective strategy for improving locoregional control in LARC patients, particularly those with positive nodes.
- Further prospective studies are warranted to validate these results and refine treatment protocols for lateral node management in LARC.
- This approach holds promise for enhancing oncologic outcomes in patients managed nonoperatively or receiving short-course radiation.
