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Can we omit prophylactic inguinal nodal irradiation in anal cancer patients?

Kim H, Park HC, Yu JI, Choi DH, Ahn YC, Kim ST, Park JO, Park YS, Kim HC - Radiat Oncol J (2015)

Bottom Line: Among the survival, the median follow-up duration was 51 months (range, 12 to 218 months).The 5-year overall survival and PFS rates were 93.4% and 88.8%, respectively.Although none of the patients received inguinal node irradiation for prophylactic purposes, there was no inguinal recurrence.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Purpose: To evaluate the appropriateness of prophylactic inguinal nodal irradiation (PINI), we analyzed patterns of failure in anal cancer patients who were inguinal node-negative at presentation and did not receive PINI.

Materials and methods: We retrospectively reviewed the records of 33 anal cancer patients treated by definitive concurrent chemoradiation therapy (CCRT) between 1994 and 2013. Radiotherapy consisted of a total dose of 44-45 Gy (22-25 fractions in 5 weeks) on the whole pelvis, anus, and perineum. Except inguinal lymphadenopathy was present at initial diagnosis, the entire inguinal chain was not included in the radiation field. In other words, there was no PINI.

Results: The median follow-up duration was 50 months (range, 4 to 218 months). Median survival and progression-free survival (PFS) were 57 months (range, 10 to 218 months) and 50 months (range, 4 to 218 months), respectively. Among the survival, the median follow-up duration was 51 months (range, 12 to 218 months). The 5-year overall survival and PFS rates were 93.4% and 88.8%, respectively. Although none of the patients received inguinal node irradiation for prophylactic purposes, there was no inguinal recurrence.

Conclusion: Treatment of anal cancer by omitting PINI might be considered in selected patients with clinically uninvolved inguinal nodes.

No MeSH data available.


Related in: MedlinePlus

Diagram of study population, according to inguinal involvement. CCRT, concurrent chemoradiation therapy.
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Figure 1: Diagram of study population, according to inguinal involvement. CCRT, concurrent chemoradiation therapy.

Mentions: We retrospectively reviewed the records of 76 anal cancer patients who were treated between January 1, 1994 and April 8, 2013. Among these, 27 patients were excluded from the study because of biopsy-proven adenocarcinoma or melanoma (14 patients), palliative treatment (3 patients), definitive RT alone (4 patients), and incomplete treatment (6 patients). Ultimately, 49 patients with biopsy-proven squamous cell carcinoma completed definitive CCRT. Except for the patients who had inguinal lymphadenopathy at initial diagnosis (16 patients, 32.7%), 33 patients were included in this retrospective study (Fig. 1). All tumors were staged based on the seventh edition of the American Joint Committee on Cancer tumor staging criteria. Tumor assessment consisted of digital rectal examination (DRE), colonoscopy with biopsy, and abdominopelvic computed tomography (AP-CT) scan. Pelvic magnetic resonance imaging (MRI) was used starting in 2006 (14 patients, 42.4%). For metastasis work-up, chest CT) scans were conducted. In addition, positron emission tomography (PET/CT) was conducted starting in 2006 (7 patients, 21.2%). Furthermore, both clinical physical examination and abdominopelvic CT scans were carefully performed to detect inguinal nodal progression during follow-up. Revised Response Evaluation Criteria in Solid Tumors (RECIST) guidelines (ver. 1.1) were used for tumor response evaluation. Tumor response was assessed eight weeks after completion of CCRT using DRE, transrectal-ultrasonography (TR-US) or sigmoidoscopy with biopsy, and AP-CT.


Can we omit prophylactic inguinal nodal irradiation in anal cancer patients?

Kim H, Park HC, Yu JI, Choi DH, Ahn YC, Kim ST, Park JO, Park YS, Kim HC - Radiat Oncol J (2015)

Diagram of study population, according to inguinal involvement. CCRT, concurrent chemoradiation therapy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4493432&req=5

Figure 1: Diagram of study population, according to inguinal involvement. CCRT, concurrent chemoradiation therapy.
Mentions: We retrospectively reviewed the records of 76 anal cancer patients who were treated between January 1, 1994 and April 8, 2013. Among these, 27 patients were excluded from the study because of biopsy-proven adenocarcinoma or melanoma (14 patients), palliative treatment (3 patients), definitive RT alone (4 patients), and incomplete treatment (6 patients). Ultimately, 49 patients with biopsy-proven squamous cell carcinoma completed definitive CCRT. Except for the patients who had inguinal lymphadenopathy at initial diagnosis (16 patients, 32.7%), 33 patients were included in this retrospective study (Fig. 1). All tumors were staged based on the seventh edition of the American Joint Committee on Cancer tumor staging criteria. Tumor assessment consisted of digital rectal examination (DRE), colonoscopy with biopsy, and abdominopelvic computed tomography (AP-CT) scan. Pelvic magnetic resonance imaging (MRI) was used starting in 2006 (14 patients, 42.4%). For metastasis work-up, chest CT) scans were conducted. In addition, positron emission tomography (PET/CT) was conducted starting in 2006 (7 patients, 21.2%). Furthermore, both clinical physical examination and abdominopelvic CT scans were carefully performed to detect inguinal nodal progression during follow-up. Revised Response Evaluation Criteria in Solid Tumors (RECIST) guidelines (ver. 1.1) were used for tumor response evaluation. Tumor response was assessed eight weeks after completion of CCRT using DRE, transrectal-ultrasonography (TR-US) or sigmoidoscopy with biopsy, and AP-CT.

Bottom Line: Among the survival, the median follow-up duration was 51 months (range, 12 to 218 months).The 5-year overall survival and PFS rates were 93.4% and 88.8%, respectively.Although none of the patients received inguinal node irradiation for prophylactic purposes, there was no inguinal recurrence.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Purpose: To evaluate the appropriateness of prophylactic inguinal nodal irradiation (PINI), we analyzed patterns of failure in anal cancer patients who were inguinal node-negative at presentation and did not receive PINI.

Materials and methods: We retrospectively reviewed the records of 33 anal cancer patients treated by definitive concurrent chemoradiation therapy (CCRT) between 1994 and 2013. Radiotherapy consisted of a total dose of 44-45 Gy (22-25 fractions in 5 weeks) on the whole pelvis, anus, and perineum. Except inguinal lymphadenopathy was present at initial diagnosis, the entire inguinal chain was not included in the radiation field. In other words, there was no PINI.

Results: The median follow-up duration was 50 months (range, 4 to 218 months). Median survival and progression-free survival (PFS) were 57 months (range, 10 to 218 months) and 50 months (range, 4 to 218 months), respectively. Among the survival, the median follow-up duration was 51 months (range, 12 to 218 months). The 5-year overall survival and PFS rates were 93.4% and 88.8%, respectively. Although none of the patients received inguinal node irradiation for prophylactic purposes, there was no inguinal recurrence.

Conclusion: Treatment of anal cancer by omitting PINI might be considered in selected patients with clinically uninvolved inguinal nodes.

No MeSH data available.


Related in: MedlinePlus