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Research article
Makoto Ito
Aichi Cancer Center Hospital, Aichi Medical University Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0001-7733-1594
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Background: Abdominal/pelvic lymph node (LN) oligometastasis is a pattern of failure that is observed occasionally. Although radiotherapy may be useful for salvage therapy, the optimal prescription dose has not yet been clarified. This study assessed the efficacy of high-dose radiotherapy. Methods: Between 2008 and 2018, the medical records of 113 patients with 1–5 abdominal/pelvic LN oligometastases treated with definitive radiotherapy at 4 institutes were retrospectively analysed. The exclusion criteria were 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 with EQD2 ≥60 Gy were the high-dose group. Kaplan-Meier analysis was used to evaluate the endpoints of overall survival (OS), local control (LC), and progression-free survival (PFS). Univariate log-rank and multivariate Cox proportional hazards model analyses were performed to clarify predictive factors for each endpoint. Toxicity rates were compared between the high-dose and low-dose groups. Results: The primary tumour sites included the colorectum (n = 28), uterine cervix (n = 27), endometrium (n = 15), and ovaries (n = 10). The 2-year OS, LC, and PFS rates were 63.1%, 59.7%, and 19.4%, respectively. On multivariate analyses, solitary oligometastasis, high-dose radiotherapy, and long disease-free interval were associated with significantly favourable OS (hazard ratio HR: 0.48, p = 0.02), LC (HR: 0.93, p < 0.001), and PFS (HR: 0.59, p = 0.01), respectively. Although high-dose radiotherapy did not significantly improve the 2-year OS of the entire cohort (74.8% vs. 52.7% in the high-dose vs. low-dose group; p = 0.08), it showed a significant difference on subgroup analysis for solitary oligometastasis (88.8% vs. 56.3%; p = 0.009). Late grade ≥3 toxicity included ileus in 7 cases (6%) and gastrointestinal bleeding in 4 (4%). There was no significant association between the irradiation dose and toxicity incidence. Conclusions: Salvage radiotherapy was feasible for oligometastasis of the abdominal/pelvic LNs. For solitary oligometastasis, the high-dose group showed favourable results considering LC and OS.
Keywords
Oligometastasis; Oligo-recurrence; Radiotherapy; Stereotactic body radiotherapy (SBRT); Lymph node
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Received 21 Feb, 2020
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On 31 Jan, 2020
Reviewer #1 agreed
On 26 Jan, 2020
Review #1 received
Received 26 Jan, 2020
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See the published version of this preprint at BMC Cancer.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Makoto Ito
Aichi Cancer Center Hospital, Aichi Medical University Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0001-7733-1594
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Cancer.
No community comments so far
Editor assigned
On 26 May, 2020
Submission checks complete
On 25 May, 2020
Editor invited
On 25 May, 2020
No comments provided
Editorial decision: Minor revision
On 18 May, 2020
Review #2 received
Received 22 Apr, 2020
Review #1 received
Received 20 Apr, 2020
Reviewer #2 agreed
On 31 Mar, 2020
Reviewer #1 agreed
On 30 Mar, 2020
Editor assigned
On 27 Mar, 2020
Reviewers invited
Invitations sent on 27 Mar, 2020
Submission checks complete
On 26 Mar, 2020
Editor invited
On 26 Mar, 2020
Version 1
Posted 04 Oct, 2019
No comments provided
Editorial decision: Major revision
On 04 Mar, 2020
Review #3 received
Received 21 Feb, 2020
Review #2 received
Received 12 Feb, 2020
Reviewer #3 agreed
On 08 Feb, 2020
Reviewer #2 agreed
On 31 Jan, 2020
Reviewer #1 agreed
On 26 Jan, 2020
Review #1 received
Received 26 Jan, 2020
Reviewers invited
Invitations sent on 02 Dec, 2019
Submission checks complete
On 01 Oct, 2019
First submitted
On 25 Sep, 2019
Editor assigned
On 25 Sep, 2019
Editor invited
On 24 Sep, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Cancer.
Background: Abdominal/pelvic lymph node (LN) oligometastasis is a pattern of failure that is observed occasionally. Although radiotherapy may be useful for salvage therapy, the optimal prescription dose has not yet been clarified. This study assessed the efficacy of high-dose radiotherapy. Methods: Between 2008 and 2018, the medical records of 113 patients with 1–5 abdominal/pelvic LN oligometastases treated with definitive radiotherapy at 4 institutes were retrospectively analysed. The exclusion criteria were 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 with EQD2 ≥60 Gy were the high-dose group. Kaplan-Meier analysis was used to evaluate the endpoints of overall survival (OS), local control (LC), and progression-free survival (PFS). Univariate log-rank and multivariate Cox proportional hazards model analyses were performed to clarify predictive factors for each endpoint. Toxicity rates were compared between the high-dose and low-dose groups. Results: The primary tumour sites included the colorectum (n = 28), uterine cervix (n = 27), endometrium (n = 15), and ovaries (n = 10). The 2-year OS, LC, and PFS rates were 63.1%, 59.7%, and 19.4%, respectively. On multivariate analyses, solitary oligometastasis, high-dose radiotherapy, and long disease-free interval were associated with significantly favourable OS (hazard ratio HR: 0.48, p = 0.02), LC (HR: 0.93, p < 0.001), and PFS (HR: 0.59, p = 0.01), respectively. Although high-dose radiotherapy did not significantly improve the 2-year OS of the entire cohort (74.8% vs. 52.7% in the high-dose vs. low-dose group; p = 0.08), it showed a significant difference on subgroup analysis for solitary oligometastasis (88.8% vs. 56.3%; p = 0.009). Late grade ≥3 toxicity included ileus in 7 cases (6%) and gastrointestinal bleeding in 4 (4%). There was no significant association between the irradiation dose and toxicity incidence. Conclusions: Salvage radiotherapy was feasible for oligometastasis of the abdominal/pelvic LNs. For solitary oligometastasis, the high-dose group showed favourable results considering LC and OS.
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