Abstract
BackgroundAbdominal/pelvic lymph node (LN) oligometastasis, a pattern of treatment failure, is observed occasionally, and radiotherapy may work as salvage therapy. The optimal prescription dose, however, is yet to be determined. This study assessed the efficacy of high-dose radiotherapy.MethodsThe medical records of 113 patients at 4 institutes were retrospectively analysed who had 1 to 5 abdominal/pelvic LN oligometastases and were treated with definitive radiotherapy between 2008 and 2018. The exclusion criteria included non-epithelial tumours, uncontrolled primary lesions, palliative intent, and re-irradiation. The prescription dose was evaluated by using the equivalent dose in 2 Gy fractions (EQD2). Patients receiving EQD2 ≥ 60 Gy were placed into the high-dose group, and the remaining others the low-dose group. Kaplan-Meier analyses were performed to evaluate overall survival (OS), local control (LC), and progression-free survival (PFS). Univariate log-rank and multivariate Cox proportional hazards model analyses were performed to explore predictive factors. Adverse events were compared between the high-dose and low-dose groups.ResultsThe primary tumour sites included the colorectum (n = 28), uterine cervix (n = 27), endometrium (n = 15), and ovaries (n = 10). The rate of 2-year OS was 63.1%, that of LC 59.7%, and that of PFS 19.4%. On multivariate analyses, OS were significantly associated with solitary oligometastasis (hazard ratio [HR]: 0.48, p = 0.02), LC with high-dose radiotherapy (HR: 0.93, p < 0.001), and PFS with long disease-free interval (HR: 0.59, p = 0.01). Whereas high-dose radiotherapy did not significantly improve 2-year OS in the entire cohort (74.8% in the high-dose vs. 52.7% in the low-dose; p = 0.08), it did in the subgroup of solitary oligometastasis (88.8% in the high-dose vs. 56.3% in the low-dose; p = 0.009). As for Late grade ≥ 3 adverse event, ileus was observed in 7 patients (6%) and gastrointestinal bleeding in 4 (4%). No significant association between the irradiation dose and adverse event incidence was found.ConclusionsAs salvage therapy, high-dose radiotherapy was recommendable for oligometastasis in the abdominal/pelvic LNs. For solitary oligometastasis, LC and OS were significantly better in the high-dose group.
Highlights
Abdominal/pelvic lymph node (LN) oligometastasis, a pattern of treatment failure, is observed occasionally, and radiotherapy may work as salvage therapy
Reirradiation here does not refer to the second radiotherapy in the same area as the initial treatment, which was excluded in the study, but to the one performed for oligometastasis of the abdominal/pelvic LNs
The number of cases of colorectal and ovarian cancer was high in the high-dose group, while the number of cases of uterine cervix and endometrium cancer was high in the low-dose group
Summary
Ethics approval and study design This retrospective observational study was approved by ethics committee, Aichi Medical University School of Medicine in Japan (application number 2018-H211). For 3-dimensional conformal radiotherapy (3DCRT), dose constraints were defined as follows: the maximum point dose was 52 Gy to the stomach and small bowel, 62 Gy to the large bowel, and 50 Gy to the spinal cord. For high-precision radiotherapy the dose constraints were defined as follows: the stomach and small bowel received a point dose of 54 Gy (V54) for < 3 cm, the large bowel V64 for < 3 cm, and the kidneys a V50 of < 33%. Reirradiation here does not refer to the second radiotherapy in the same area as the initial treatment, which was excluded in the study, but to the one performed for oligometastasis of the abdominal/pelvic LNs. All statistical analyses were performed with EZR version 1.33 (Saitama Medical Center, Jichi Medical University, Saitama, Japan), based on the R and R commander [12]
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