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Radiological assessment of persistent retroperitoneal and lateral pelvic lymph nodes after neoadjuvant therapy for rectal cancer: An analysis of the United States Rectal Cancer Consortium
Author(s) -
Turgeon Michael K.,
Gamboa Adriana C.,
Keilson Jessica M.,
Maniko Jeffrey,
Maguire Lillias,
Hrebinko Katherine,
HolderMurray Jennifer,
Wiseman Jason T.,
AbdelMisih Sherif,
Hamdan Saif,
Hawkins Alexander T.,
Bauer Philip,
Silviera Matthew,
Maithel Shishir K.,
Balch Glen C.
Publication year - 2021
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.26600
Subject(s) - medicine , neoadjuvant therapy , colorectal cancer , radiography , surgery , radiology , cancer , oncology , breast cancer
Management of retroperitoneal and lateral pelvic lymph nodes (RLPN) in rectal cancer remains unclear. With total neoadjuvant therapy (TNT), more patients have radiologic complete clinical response (rCR). We sought to evaluate the impact of radiographic persistent RLPN after neoadjuvant therapy on survival. Materials and Methods Patients with rectal adenocarcinoma with isolated RLPN metastasis, who received neoadjuvant therapy before surgery were included from the United States Rectal Cancer Consortium database. Primary outcomes were recurrence‐free survival (RFS) and overall survival (OS). Results Of 77 patients, all received neoadjuvant therapy, with 35 (46%) receiving TNT. Posttreatment, 33 (43%) had rCR while 44 (57%) had radiographic persistent RLPN. Median number of radiographic positive RLPN was 1 (IQR 1–2). Receipt of TNT was associated with radiographic RLPN rCR (OR 4.77, 95% CI 1.81–12.60, p < .01). However, there was no difference in RFS and OS between patients who achieved rCR or with persistent RLPN (all p > .05). Conclusions Radiographic persistence of RLPN was not associated with worse survival in well‐selected patients and may not be a reliable indicator of pathological response. TNT may be the preferred management strategy to select patients given its association with rCR. Radiographic persistence of RLPN after preoperative therapy should not necessarily preclude surgery.