Effect of local treatment on lateral pelvic lymph node metastasis in rectal cancer / 中华放射肿瘤学杂志

ABSTRACT

Lateral pelvic lymph node (LPLN) metastasis is a poor prognostic factor for rectal cancer, which is more common in low site, T 3-T 4 stage, and positive lymph nodes in mesorectum. However, there is no accurate predictor of metastasis. At present, high-resolution MRI is the optimal diagnosis of LPLN metastasis, but the threshold value is still unclear. The treatment mode of LPLN metastasis in locally advanced rectal cancer is controversial worldwide. European and American countries advocate chemoradiotherapy combined with total mesorectal resection, while Japan recommends total mesorectal resection combined with LPLN dissection. The combination of radiotherapy and surgery could achieve good local control. Further more, by using the information of lateral lymph nodes before and after radiotherapy, patients with high risk can be screened for intensive treatment, such as LPLN dissection or dose-escalation approaches. Currently, there is still a lack of high-quality evidence on the efficacy of various approaches in the treatment of LPLN metastasis, and more research is needed to improve the treatment strategies.