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Incorporation of radiotherapy in the multidisciplinary treatment of isolated retroperitoneal lymph node recurrence from colorectal cancer

Authors
 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 Koom 
Citation
 ANNALS OF SURGICAL ONCOLOGY, Vol.22(5) : 1520-1526, 2015 
Journal Title
 ANNALS OF SURGICAL ONCOLOGY 
ISSN
 1068-9265 
Issue Date
2015
MeSH
Colorectal Neoplasms/mortality ; Colorectal Neoplasms/pathology ; Colorectal Neoplasms/therapy* ; Combined Modality Therapy ; Female ; Follow-Up Studies ; Humans ; Lymph Nodes/pathology* ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local/mortality ; Neoplasm Recurrence, Local/pathology ; Neoplasm Recurrence, Local/radiotherapy* ; Neoplasm Staging ; Neoplasms/drug therapy* ; Neoplasms/pathology ; Prognosis ; Retroperitoneal Neoplasms/mortality ; Retroperitoneal Neoplasms/pathology ; Retroperitoneal Neoplasms/radiotherapy* ; Salvage Therapy* ; Survival Rate
Keywords
Overall Survival ; Renal Vein ; Clinical Target Volume ; Gross Tumor Volume ; Helical Tomotherapy
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.
Full Text
http://link.springer.com/article/10.1245%2Fs10434-014-4363-5
DOI
10.1245/s10434-014-4363-5
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Keum, Ki Chang(금기창) ORCID logo https://orcid.org/0000-0003-4123-7998
Koom, Woong Sub(금웅섭) ORCID logo https://orcid.org/0000-0002-9435-7750
Kim, Nam Kyu(김남규) ORCID logo https://orcid.org/0000-0003-0639-5632
Kim, Tae Il(김태일) ORCID logo https://orcid.org/0000-0003-4807-890X
Shin, Sang Joon(신상준) ORCID logo https://orcid.org/0000-0001-5350-7241
Ahn, Joong Bae(안중배) ORCID logo https://orcid.org/0000-0001-6787-1503
Lee, Jeong Shim(이정심)
Lim, Joon Seok(임준석) ORCID logo https://orcid.org/0000-0002-0334-5042
Chang, Jee Suk Paul(장지석) ORCID logo https://orcid.org/0000-0001-7685-3382
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/139789
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