Lymph node response to chemoradiotherapy in oesophageal cancer patients: relationship with radiotherapy fields
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ORIGINAL ARTICLE
Lymph node response to chemoradiotherapy in oesophageal cancer patients: relationship with radiotherapy fields Willem J. Koemans1,2,3 · Ruben T. H. M. Larue4,5 · Maximilian Kloft2 · Jessica E. Ruisch2 · Inge Compter4 · Robert G. Riedl6 · Lara R. Heij7,8 · Wouter van Elmpt4 · Maaike Berbée4 · Jeroen Buijsen4 · Philippe Lambin5 · Meindert N. Sosef1 · Heike I. Grabsch2,9 Received: 4 February 2020 / Accepted: 24 August 2020 © The Author(s) 2020
Abstract Background The presence of lymph node metastasis (LNmets) is a poor prognostic factor in oesophageal cancer (OeC) patients treated with neoadjuvant chemoradiotherapy (nCRT) followed by surgery. Tumour regression grade (TRG) in LNmets has been suggested as a predictor for survival. The aim of this study was to investigate whether TRG in LNmets is related to their location within the radiotherapy (RT) field. Methods Histopathological TRG was retrospectively classified in 2565 lymph nodes (LNs) from 117 OeC patients treated with nCRT and surgery as: (A) no tumour, no signs of regression; (B) tumour without regression; (C) viable tumour and regression; and (D) complete response. Multivariate survival analysis was used to investigate the relationship between LN location within the RT field, pathological TRG of the LN and TRG of the primary tumour. Results In 63 (54%) patients, viable tumour cells or signs of regression were seen in 264 (10.2%) LNs which were classified as TRG-B (n = 56), C (n = 104) or D (n = 104) LNs. 73% of B, C and D LNs were located within the RT field. There was a trend towards a relationship between LN response and anatomical LN location with respect to the RT field (p = 0.052). Multivariate analysis showed that only the presence of LNmets within the RT field with TRG-B is related to poor overall survival. Conclusion Patients have the best survival if all LNmets show tumour regression, even if LNmets are located outside the RT field. Response in LNmets to nCRT is heterogeneous which warrants further studies to better understand underlying mechanisms. Keywords Oesophageal cancer · Neoadjuvant chemoradiotherapy · Lymph node regression · Radiation field Abbreviations LN-TRG Tumour regression in lymph nodes nCRT Neoadjuvant chemoradiotherapy LNs Lymph nodes Abstract presented on the 11th Joint Meeting of the British Division of the International Academy of Pathology and the Pathological Society of Great Britain & Ireland, 2018. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10388-020-00777-y) contains supplementary material, which is available to authorized users. Willem J. Koemans and Ruben T. H. M. Larue: Joint first author. Meindert N. Sosef and Heike I. Grabsch: Joint last author. * Heike I. Grabsch [email protected] Extended author information available on the last page of the article
RT Radiotherapy OeC Oesophageal cancer TRG Tumour regression grade ENI Elective lymph node irradiation LNmets Lymph node metastasis LN Lymph node GTV Gross tumour v
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