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Mapping of lateral pelvic lymph node recurrences in rectal cancer: a radiation oncologist's perspective

 Seo Hee Choi  ;  Jee Suk Chang  ;  Hong In Yoon  ;  Dong-Su Jang  ;  Nam Kyu Kim  ;  Joon Seok Lim  ;  Byung So Min  ;  Hyuk Huh  ;  Sang Joon Shin  ;  Joong Bae Ahn  ;  Woong Sub Koom 
 Journal of Cancer Research and Clinical Oncology, Vol.144(6) : 1119-1128, 2018 
Journal Title
 Journal of Cancer Research and Clinical Oncology 
Issue Date
Female ; Humans ; Lymph Node Excision ; Lymph Nodes/*pathology/*radiation effects/surgery ; Lymphatic Metastasis ; Male ; Middle Aged ; Local/pathology Neoplasm Recurrence ; Neoplasm Staging ; Pelvis ; Radiation Oncologists ; Rectal Neoplasms/*pathology/*radiotherapy/surgery ; Retrospective Studies
Clinical target volume ; Lateral lymph node ; Rectal cancer ; Recurrence patterns
PURPOSE: Patterns of locoregional rectal cancer recurrences following total mesorectal excision (TME) were analyzed to define the irradiation volume, especially the lateral pelvic lymph node (LPLN). MATERIALS AND METHODS: Of 1243 patients who underwent TME without pelvic radiotherapy between 2005 and 2012, the data of 826 patients with rectal adenocarcinoma without distant metastases were analyzed for relapse patterns, categorized as distant and locoregional (anastomosis, mesorectum, presacral area, and LPLNs) failure. RESULTS: The median follow-up was 61.8 months. The 5-year local recurrence-free, distant metastasis-free, overall survival rates were 88, 82, and 89%, respectively. Relapse occurred in 108 (13%) patients: 90 (11%) had distant and 28 (3%) had locoregional failure. Eight patients had LPLN recurrence: the 2 recurrences from upper rectal cancers occurred near the bifurcation of the common iliac artery into the external and internal iliac vessels; the 6 mid-lower rectal cancers had 16 recurrences near the internal iliac and obturator arteries-five occurred anterior to the obturator artery and posterior to the external iliac artery, superior to the femoral head. LPLN recurrence was associated with pN2 stage, perinodal extension, and lymphovascular invasion. CONCLUSION: The LPLN component of pre- or postoperative irradiation volumes could potentially be optimized based on our mapping data. However, since patients in our institution at high risk for relapse received either preoperative or postoperative chemoradiation, further analyses are needed to confirm our findings.
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1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
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
Min, Byung Soh(민병소)
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
Yoon, Hong In(윤홍인) ORCID logo https://orcid.org/0000-0002-2106-6856
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
Hur, Hyuk(허혁) ORCID logo https://orcid.org/0000-0002-9864-7229
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