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Multimodality Therapy and Lateral Local Recurrence in Rectal Cancer

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Key Points

  • Half of patients with local recurrence had lateral local recurrence.
  • Among patients with lateral lymph nodes ≥ 7 mm, those undergoing chemoradiation or radiation, total mesorectal excision, and LLND had a 5-year lateral local recurrence rate of 5.7% vs a 5-year rate of 19.5% among those not undergoing LLND.

In a study reported in the Journal of Clinical Oncology, Ogura et al found that lateral lymph node dissection (LLND) reduced the risk of lateral local recurrence in patients with lateral nodes ≥ 7 mm undergoing neoadjuvant chemoradiation or radiation and total mesorectal excision in clinical stage (cT3/4) low rectal cancer.

The study involved data from 1,216 consecutive patients from 12 hospitals in 7 countries with cT3/4 rectal cancers up to 8 cm from the anal verge who underwent surgery between January 2009 and December 2013. Among these, LLND was performed in 142 patients (12%).

Lateral Local Recurrence

Pretreatment magnetic resonance imaging showed that 703 patients (58%) had visible lateral lymph nodes, with 192 (16%) having a short axis of ≥ 7 mm. A total of 108 patients developed local recurrence (5-year rate = 10.0%); of these, 59 (54%) had lateral local recurrence (5-year lateral local recurrence rate = 5.5%).

On multivariate analysis, lateral lymph nodes with a short axis ≥ 7 mm were associated with a significantly higher risk of lateral local recurrence (hazard ratio = 2.06, P = .045) compared with lateral lymph nodes < 7 mm. Among patients with lateral lymph nodes ≥ 7 mm, those undergoing chemoradiation or radiation, total mesorectal excision, and LLND had a 5-year lateral local recurrence rate of 5.7% vs a 5-year rate of 19.5% (P = .042) among those not undergoing LLND.

The investigators concluded, “[Lateral local recurrence] is still a significant problem after [chemoradiation or radiation] plus [total mesorectal excision] in [lateral lymph nodes] with a short axis at least 7 mm on pretreatment [magnetic resonance imaging]. The addition of LLND results in a significantly lower [lateral local recurrence] rate.”

Miranda Kusters, MD, PhD, of Amsterdam University Medical Centers, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: See study authors’ full disclosures at jco.ascopubs.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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