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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

Diseases of the Colon & Rectum: May 2014 - Volume 57 - Issue 5 - p 578–584
doi: 10.1097/DCR.0000000000000050
Original Contributions: Colorectal/Anal Neoplasia

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.

1Department of Radiation Oncology, Erasmus MC Daniel den Hoed Oncology Centre, Rotterdam, The Netherlands

2Department of Surgical Oncology, Erasmus MC Daniel den Hoed Oncology Centre, Rotterdam, The Netherlands

Financial Disclosure: The authors claim no conflicts of interest.

Poster Presentation at ASTRO Annual Meeting, Boston, Massachusetts, October 28-31 2012

Correspondence: S. E. Blinde, M.D., Erasmus MC Daniel den Hoed Oncology Centre, Groene Hilledijk 301, 3075 EA Rotterdam, The Netherlands. E-mail:

© 2014 The American Society of Colon and Rectal Surgeons