Skip Navigation LinksHome > May 2014 - Volume 57 - Issue 5 > Inguinal Lymph Node Recurrence in the Untreated Groin of Pat...
Diseases of the Colon & Rectum:
doi: 10.1097/DCR.0000000000000050
Original Contributions: Colorectal/Anal Neoplasia

Inguinal Lymph Node Recurrence in the Untreated Groin of Patients with Anal Carcinoma

Blinde, Sanne E. M.D.1; Schasfoort, Renske M.D.1; Mens, Jan Willem M.D.1; Verhoef, Cornelis M.D., Ph.D.2; Olofsen, Manouk M.D., Ph.D.1; Nuyttens, Joost J. M.D., Ph.D.1

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Abstract

BACKGROUND: Inguinal lymph node metastasis is predictive of locoregional recurrence and poor overall survival in anal carcinoma. Metachronous lymph node metastasis occurs in 10% of all anal cancer patients, but multiple studies have shown that the benefit of elective irradiation of the groin depends on T-stage, and the toxicity of groin irradiation must not be underestimated.

OBJECTIVE: To analyze the inguinal recurrence rates among patients with anal carcinoma (T1-4, N0-1) who did not receive elective irradiation therapy to the groin and to determine predictors of inguinal recurrence.

DESIGN: Data on 119 patients treated between 1987 and 2005 were retrospectively analyzed. Patients were treated with 3-dimensional radiotherapy. The median dose was 60 Gy. During radiotherapy, 108 patients also received chemotherapy (5-fluorouracil and mitomycin-C).

RESULTS: AJCC staging showed a distribution of 21 T1 (18%), 58 T2 (49%), 27 T3 (23%), 13 T4 (11%), 101 N0 (85%) and 18 N1 (15%) tumors. The median follow up was 65 months (range, 1–240 months). The 5-year inguinal recurrence rate was 0% for T1, 10% for T2, 21% for T3 and 19% for T4 tumors (p = 0.034). T2 tumors of the perianal skin and the anal canal had 5-year inguinal recurrence rates of 12% and 8%, respectively. The 5-year inguinal recurrence rate was 21% for tumors ≥4 cm vs. 2% for tumors <4 cm in size (p = 0.003).

LIMITATIONS: Eleven patients did not receive chemotherapy.

CONCLUSIONS: Elective irradiation of the groin should be considered for local control in patients (N0-N1) with T2 tumors ≥4 cm in size and/or located in the perianal skin, and in all patients with T3 and T4 tumors.

© 2014 The American Society of Colon and Rectal Surgeons

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