| Shen Jinxia,Du Dexi,He Huijuan,Li Ming,Zhou Zhenzhen,Ding Shubo.Effect of simultaneous integrated boost intensity-modulated radiation therapy on lateral lymph node metastasis in rectal cancer[J].Chinese Journal of Radiological Medicine and Protection,2023,43(11):866-872 |
| Effect of simultaneous integrated boost intensity-modulated radiation therapy on lateral lymph node metastasis in rectal cancer |
| Received:April 04, 2023 |
| DOI：10.3760/cma.j.cn112271-20230404-00106 |
| KeyWords:Rectal cancer Lateral lymph node metastasis Simultaneous integrated boost intensity-modulated radiation therapy Lateral recurrence |
| FundProject:浙江省医药卫生科技计划项目(2020KY1002);金华市科学技术研究计划重点项目(2019-3-014);浙江省医学会临床科研基金项目(2018ZYC-A125) |
| Author Name | Affiliation | E-mail | | Shen Jinxia | Department of Radiation Oncology, Zhejiang University Jinhua Hospital, Jinhua Municipal Central Hospital, Jinhua 321000, China | | | Du Dexi | Department of Radiation Oncology, Lishui Municipal Central Hospital, Lishui 323020, China | | | He Huijuan | Department of Radiation Oncology, People's Hospital of Quzhou, Quzhou 324000, China | | | 徐辛敏 | Department of Radiation Oncology, Zhejiang University Jinhua Hospital, Jinhua Municipal Central Hospital, Jinhua 321000, China | | | Li Ming | Department of Radiation Oncology, Zhejiang University Jinhua Hospital, Jinhua Municipal Central Hospital, Jinhua 321000, China | | | Zhou Zhenzhen | Department of Radiation Oncology, Zhejiang University Jinhua Hospital, Jinhua Municipal Central Hospital, Jinhua 321000, China | | | Ding Shubo | Department of Radiation Oncology, Zhejiang University Jinhua Hospital, Jinhua Municipal Central Hospital, Jinhua 321000, China | jhyyys@163.com |
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| Abstract:: |
| Objective To evaluate the efficacy and safety of simultaneous integrated boost intensity-modulated radiation therapy (SIB-IMRT) for rectal cancer with lateral lymph node metastasis (LLNM).Methods From January 2016 to December 2022, 103 rectal cancer patients with LLNM were enrolled. The patients were divided into SIB-IMRT group (52 cases) and conventional chemoradiotherapy (CRT) group (51 cases) using the random number table method. The dose was 50 Gy for the pelvis with 60 Gy of SIB-IMRT for the LLNM in the SIB-IMRT group. The dose was 50 Gy for the pelvis in the CRT group. The primary endpoint was the lateral recurrence rate. The efficacy and adverse reactions of the two groups were compared.Results The adverse reactions and surgical complications after neoadjuvant radiotherapy were comparable between the two groups. The response rates of LLNM treatment were 76.9% and 56.9%, respectively, in the two groups (χ2=4.69, P=0.03). The SIB-IMRT group and CRT group had a local recurrence rate of 7.7% and 25.5% (χ2=5.92, P=0.015), respectively, and a lateral recurrence rate of 3.8% and 23.5% (χ2=8.49, P=0.004), respectively. Univariate analysis showed that the SIB-IMRT, short axis of lateral lymph nodes <5 mm after radiotherapy, and negative result in the postoperative lymph node pathological examination were factors associated with lateral recurrence. Multivariable regression analysis demonstrated that the SIB-IMRT (HR=6.42, 95%CI: 1.40-29.49) and short axis of lateral lymph nodes <5 mm after radiotherapy (HR=0.17, 95%CI: 0.04-0.66) were independent factors associated with lateral recurrence. The two groups had a 3-year disease-free survival of 73.25% and 62.6% (P>0.05), respectively, and a 3-year overall survival of 87% and 82.5% (P>0.05), respectively.Conclusions The SIB-IMRT is safe and effective for rectal cancer with LLNM. The short axis of lateral lymph nodes <5 mm after neoadjuvant radiotherapy and SIB-IMRT is an independent risk factor for lateral recurrence. |
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