Stereotactic body radiotherapy for isolated paraaortic lymph node recurrence from colorectal cancer

AIM:To evaluate the efficacy and complications of stereotactic body radiotherapy in localized paraaortic lymph node recurrence from colorectal cancer.METHODS:From 2003 to 2009,7 patients with paraaortic lymph node recurrence(1-3 lesions)from colorectal cancer were treated with stereotactic body radiotherapy.Total gross tumor volumes ranged from 4 to 40 mL.The doses were escalated from 36 Gy/patient to 51 Gy/patient and were delivered in 3 fractions.RESULTS:One and 3 year overall survival rates were 100%and 71.4%,respectively,and median survival was 37 mo.GradeⅣintestinal obstruction was reported in 1 of 7 patients.This patient received 48 Gy in 3 fractions with a maximum point dose to the intestine of 53 Gy and V45Gy=3.6 mL.However,6 patients received an intestinal maximum point dose of<51 Gy and V45Gy of<1 mL,and did not develop any severe complications.CONCLUSION:This pilot study suggests selected paraaortic lymph node recurrence(1-3 closed lesions) that failed to respond to chemotherapy can be potentially salvaged by stereotactic body radiotherapy.

Stereotactic body radiotherapy for oligo-recurrence within the nodal area from colorectal cancer

Recurrence of colorectal cancer(CRC)often presents as solitary metastases,oligometastases or oligo-recurrence.Surgical resection became the preferred treatment for patients with CRC lung and hepatic metastases.However,surgical treatment for oligo-recurrence within nodal area is not a widely accepted treatment due to due to their relative rarity and high postoperative morbidity.Stereotactic body radiotherapy(SBRT)is one of the emerging radiation treatment techniques in which a high radiation dose can be delivered to the tumor.High-dose SBRT can ablate the tumor with an efficacy similar to that achieved with surgery,especially for small tumors.However,there have been very few studies on SBRT for oligo-recurrence within nodal area,although several studies have evaluated the role of SBRT in the treatment of liver and lung metastases from CRC.This article reviews the current clinical status of and treatment methods for oligo-recurrence within nodal area from CRC,with particular emphasis on SBRT.