title: Local Recurrence in the Lateral Lymph Node Compartment: Improved Outcomes with Induction Chemotherapy Combined with Multimodality Treatment.
abstract: Lateral nodal disease is of major importance in the treatment of rectal cancer in the East, but a mostly neglected entity in the West. In this article, the treatment of recurrences in the lateral compartment (latLRs) in a national tertiary referral center is evaluated.
  
  
  
  Of 214 patients with locally recurrent rectal cancer who underwent multimodality treatment in the Catharina Hospital in the last 10 years, a total of 51 patients with latLR were selected (the latLR region was classified as upper, middle, or lower). Thirteen (25 %) of these patients underwent induction chemotherapy (ICT) prior to chemo(re)irradiation.
  
  
  
  LatLRs occurred mainly after low and N+ primary tumors. Seven (14 %) patients had a complete response (pCR) and 28 (55 %) underwent an R0 resection. Patients with a lower latLR had the highest chance of undergoing an abdominoperineal resection and resection of anterior organs. ICT resulted in a 31 % pCR rate compared with 8 % without ICT (p = 0.039). Patients who received ICT had an 85 % R0 resection rate, while this was 45 % in patients who did not receive ICT (p = 0.013). The 5-year local re-recurrence (LRR) rate was 64.3 %, and overall survival (OS) was 34.2 %; the only factor improving these was an R0 resection. Five-year survival after multivariate analyses was 10.3 % after an R+ resection compared with 66.8 % after an R0 resection (p = 0.011).
  
  
  
  LatLRs impose a major surgical challenge and result in high LRR and low OS. More R0 resections can possibly be achieved with ICT, which is the only factor that can improve LRR and OS.
authors: Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands. miranda.kusters@catharinaziekenhuis.nl.
authors: Miranda
authors: M
authors: Kusters
authors: Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
authors: Sietske J
authors: SJ
authors: Bosman
authors: Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
authors: Desley M G I
authors: DM
authors: Van Zoggel
authors: Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
authors: Grard A P
authors: GA
authors: Nieuwenhuijzen
authors: Department of Medical Oncology, Catharina Hospital, Eindhoven, The Netherlands.
authors: Geert-Jan
authors: GJ
authors: Creemers
authors: Department of Radiation Oncology, Catharina Hospital, Eindhoven, The Netherlands.
authors: Hetty A
authors: HA
authors: Van den Berg
authors: Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.|Department of Surgery, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, The Netherlands.
authors: Harm J T
authors: HJ
authors: Rutten
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D060828:Induction Chemotherapy; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D012074:Remission Induction; D015996:Survival Rate