title: Inguinal lymph node recurrence in the untreated groin of patients with anal carcinoma.
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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Sanne E
authors.initials: SE
authors.lastname: Blinde
authors.forename: Renske
authors.initials: R
authors.lastname: Schasfoort
authors.forename: Jan Willem
authors.initials: JW
authors.lastname: Mens
authors.forename: Cornelis
authors.initials: C
authors.lastname: Verhoef
authors.forename: Manouk
authors.initials: M
authors.lastname: Olofsen
authors.forename: Joost J
authors.initials: JJ
authors.lastname: Nuyttens
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001005:Anus Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006119:Groin / Q000473:pathology*; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents; D016685:Mitomycin; D005472:Fluorouracil