{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T23:21:39Z","timestamp":1791588099065,"version":"4.3.4"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T00:00:00Z","timestamp":1638316800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,12,4]],"date-time":"2021-12-04T00:00:00Z","timestamp":1638576000000},"content-version":"vor","delay-in-days":3,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002858","name":"China Postdoctoral Science Foundation","doi-asserted-by":"crossref","award":["No.2020M682608"],"award-info":[{"award-number":["No.2020M682608"]}],"id":[{"id":"10.13039\/501100002858","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["NO. 82102837"],"award-info":[{"award-number":["NO. 82102837"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100021171","name":"Guangdong Basic and Applied Basic Research Foundation","doi-asserted-by":"crossref","award":["NO. 2020A1515110074"],"award-info":[{"award-number":["NO. 2020A1515110074"]}],"id":[{"id":"10.13039\/501100021171","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Discov Onc"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Some patients with locally advanced rectal cancer (LARC) present with inguinal lymph node metastases without evidence of other systemic disease, known as solitary inguinal lymph node metastasis (SILNM). These patients may represent a distinct subset who have a more favorable prognosis and should be treated with curative intent. The optimal treatment strategy for these patients has not been determined.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We retrospectively reviewed 16 consecutive LARC patients diagnosed between January 2017 and December 2019, who had SILNM, were treated with an inguinal lymph nodes (ILN) radiation boost with curative intent during neoadjuvant chemoradiotherapy (nCRT) and underwent total mesorectal excision (TME). We used Kaplan\u2013Meier survival curves to calculate survival rates, and recorded radiation-related toxicity.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>None of these 16 patients developed pelvic or inguinal recurrences, and 3 of the patients developed distant metastases. The 3-year overall survival rate and locoregional relapse-free survival rate were both 100%. The 3-year disease-free rate and distant metastasis-free survival rate were both 81.3%. Of 5 patients who had ILN dissection for suspicious ILNs after neoadjuvant treatment, 2 had residual nodal tumor confirmed. Grade 3 toxicity was found in 5 patients, and no patients had lymphedema or other grade 4 or 5 toxicities.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>In LARC patients with synchronous SILNM, a radiation boost to the ILNs during nCRT achieved excellent local control with acceptable toxicity. Though the optimal treatment strategy remains unclear, nCRT with an ILN radiation boost prior to TME may be a reasonable therapeutic approach to consider for this subset of patients.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s12672-021-00455-0","type":"journal-article","created":{"date-parts":[[2021,12,4]],"date-time":"2021-12-04T04:30:07Z","timestamp":1638592207000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Radiation boost for synchronous solitary inguinal lymph node metastasis during neoadjuvant chemoradiotherapy for locally advanced rectal cancer"],"prefix":"10.1007","volume":"12","author":[{"given":"Mo","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuai","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han-chen","family":"Yi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanping","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fang","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,12,4]]},"reference":[{"key":"455_CR1","doi-asserted-by":"publisher","first-page":"1454","DOI":"10.1245\/s10434-018-6462-1","volume":"25","author":"MR Weiser","year":"2018","unstructured":"Weiser MR. AJCC 8th edition: colorectal cancer. Ann Surg Oncol. 2018;25:1454\u20135.","journal-title":"Ann Surg Oncol"},{"key":"455_CR2","doi-asserted-by":"publisher","first-page":"1134","DOI":"10.1245\/s10434-019-07191-4","volume":"26","author":"JAW Hagemans","year":"2019","unstructured":"Hagemans JAW, Rothbarth J, van Bogerijen GHW, et al. Treatment of inguinal lymph node metastases in patients with rectal adenocarcinoma. Ann Surg Oncol. 2019;26:1134\u201341.","journal-title":"Ann Surg Oncol"},{"key":"455_CR3","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1097\/00000658-194208000-00005","volume":"116","author":"RS Grinnell","year":"1942","unstructured":"Grinnell RS. The lymphatic and venous spread of carcinoma of the rectum. Ann Surg. 1942;116:200\u201316.","journal-title":"Ann Surg"},{"key":"455_CR4","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1007\/BF02134182","volume":"33","author":"RA Graham","year":"1990","unstructured":"Graham RA, Hohn DC. Management of inguinal lymph node metastases from adenocarcinoma of the rectum. Dis Colon Rectum. 1990;33:212\u20136.","journal-title":"Dis Colon Rectum"},{"key":"455_CR5","doi-asserted-by":"publisher","first-page":"1675","DOI":"10.1007\/s00384-013-1746-1","volume":"28","author":"T Adachi","year":"2013","unstructured":"Adachi T, Hinoi T, Egi H, et al. Surgical treatment for isolated inguinal lymph node metastasis in lower rectal adenocarcinoma patients improves outcome. Int J Colorectal Dis. 2013;28:1675\u201380.","journal-title":"Int J Colorectal Dis"},{"key":"455_CR6","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1111\/j.1463-1318.2009.01821.x","volume":"12","author":"A Bardia","year":"2010","unstructured":"Bardia A, Greeno E, Miller R, et al. Is a solitary inguinal lymph node metastasis from adenocarcinoma of the rectum really a metastasis? Colorectal Dis. 2010;12:312\u20135.","journal-title":"Colorectal Dis"},{"key":"455_CR7","doi-asserted-by":"publisher","first-page":"2212","DOI":"10.1245\/s10434-011-2210-5","volume":"19","author":"E Al-Sukhni","year":"2012","unstructured":"Al-Sukhni E, Milot L, Fruitman M, et al. Diagnostic accuracy of MRI for assessment of T category, lymph node metastases, and circumferential resection margin involvement in patients with rectal cancer: a systematic review and meta-analysis. Ann Surg Oncol. 2012;19:2212\u201323.","journal-title":"Ann Surg Oncol"},{"key":"455_CR8","doi-asserted-by":"publisher","first-page":"244","DOI":"10.3389\/fonc.2019.00244","volume":"9","author":"Y Cheng","year":"2019","unstructured":"Cheng Y, Ma Y, Zheng J, et al. Impact of chemotherapy regimens on normal tissue complication probability models of acute hematologic toxicity in rectal cancer patients receiving intensity modulated radiation therapy with concurrent chemotherapy from a prospective phase III clinical trial. Front Oncol. 2019;9:244.","journal-title":"Front Oncol"},{"key":"455_CR9","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1016\/S0002-9610(05)80204-1","volume":"168","author":"TW Mesko","year":"1994","unstructured":"Mesko TW, Rodriguez-Bigas MA, Petrelli NJ. Inguinal lymph node metastases from adenocarcinoma of the rectum. Am J Surg. 1994;168:285\u20137.","journal-title":"Am J Surg"},{"key":"455_CR10","doi-asserted-by":"publisher","first-page":"887","DOI":"10.1245\/s10434-009-0324-9","volume":"16","author":"M Bebenek","year":"2009","unstructured":"Bebenek M, Wojnar A. Infralevator lymphatic drainage of low-rectal cancers: preliminary results. Ann Surg Oncol. 2009;16:887\u201392.","journal-title":"Ann Surg Oncol"},{"key":"455_CR11","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1186\/s13014-014-0296-1","volume":"9","author":"SG Yeo","year":"2014","unstructured":"Yeo SG, Lim HW, Kim DY, et al. Is elective inguinal radiotherapy necessary for locally advanced rectal adenocarcinoma invading anal canal? Radiat Oncol. 2014;9:296.","journal-title":"Radiat Oncol"},{"key":"455_CR12","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1016\/j.clon.2015.11.003","volume":"28","author":"S Gollins","year":"2016","unstructured":"Gollins S, Sebag-Montefiore D. Neoadjuvant treatment strategies for locally advanced rectal cancer. Clin Oncol. 2016;28:146\u201351.","journal-title":"Clin Oncol"},{"key":"455_CR13","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1016\/j.ijrobp.2012.05.017","volume":"85","author":"AL Appelt","year":"2013","unstructured":"Appelt AL, Pl\u00f8en J, Vogelius IR, et al. Radiation dose-response model for locally advanced rectal cancer after preoperative chemoradiation therapy. Int J Radiat Oncol Biol Phys. 2013;85:74\u201380.","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"455_CR14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.radonc.2014.08.035","volume":"113","author":"JP Burbach","year":"2014","unstructured":"Burbach JP, den Harder AM, Intven M, et al. Impact of radiotherapy boost on pathological complete response in patients with locally advanced rectal cancer: a systematic review and meta-analysis. Radiother Oncol. 2014;113:1\u20139.","journal-title":"Radiother Oncol"},{"key":"455_CR15","doi-asserted-by":"publisher","first-page":"1008","DOI":"10.1016\/j.ijrobp.2020.06.013","volume":"108","author":"AM Couwenberg","year":"2020","unstructured":"Couwenberg AM, Burbach JPM, Berbee M, et al. Efficacy of dose-escalated chemoradiation on complete tumor response in patients with locally advanced rectal cancer (RECTAL-BOOST): a phase 2 randomized controlled trial. Int J Radiat Oncol Biol Phys. 2020;108:1008\u201318.","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"455_CR16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.clcc.2017.06.008","volume":"17","author":"AJ Franke","year":"2018","unstructured":"Franke AJ, Parekh H, Starr JS, et al. Total neoadjuvant therapy: a shifting paradigm in locally advanced rectal cancer management. Clin Colorectal Cancer. 2018;17:1\u201312.","journal-title":"Clin Colorectal Cancer"},{"key":"455_CR17","doi-asserted-by":"publisher","first-page":"440","DOI":"10.1097\/SLA.0000000000003471","volume":"271","author":"F Petrelli","year":"2020","unstructured":"Petrelli F, Trevisan F, Cabiddu M, et al. Total neoadjuvant therapy in rectal cancer: a systematic review and meta-analysis of treatment outcomes. Ann Surg. 2020;271:440\u20138.","journal-title":"Ann Surg"},{"key":"455_CR18","doi-asserted-by":"publisher","first-page":"741","DOI":"10.1016\/S0360-3016(01)01687-X","volume":"51","author":"N Taylor","year":"2001","unstructured":"Taylor N, Crane C, Skibber J, et al. Elective groin irradiation is not indicated for patients with adenocarcinoma of the rectum extending to the anal canal. Int J Radiat Oncol Biol Phys. 2001;51:741\u20137.","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"455_CR19","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1007\/s00595-003-2738-5","volume":"34","author":"H Tonouchi","year":"2004","unstructured":"Tonouchi H, Ohmori Y, Kobayashi M, et al. Operative morbidity associated with groin dissections. Surg Today. 2004;34:413\u20138.","journal-title":"Surg Today"},{"key":"455_CR20","doi-asserted-by":"publisher","first-page":"2058","DOI":"10.1002\/1097-0142(19930915)72:6<2058::AID-CNCR2820720643>3.0.CO;2-U","volume":"72","author":"WR Lee","year":"1993","unstructured":"Lee WR, McCollough WM, Mendenhall WM, et al. Elective inguinal lymph node irradiation for pelvic carcinomas. The University of Florida experience. Cancer. 1993;72:2058\u201365.","journal-title":"Cancer"},{"key":"455_CR21","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1007\/s00384-020-03520-2","volume":"35","author":"H Shiratori","year":"2020","unstructured":"Shiratori H, Nozawa H, Kawai K, et al. Risk factors and therapeutic significance of inguinal lymph node metastasis in advanced lower rectal cancer. Int J Colorectal Dis. 2020;35:655\u201364.","journal-title":"Int J Colorectal Dis"},{"key":"455_CR22","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1016\/j.ijrobp.2005.05.052","volume":"63","author":"YJ Chen","year":"2005","unstructured":"Chen YJ, Liu A, Tsai PT, et al. Organ sparing by conformal avoidance intensity-modulated radiation therapy for anal cancer: dosimetric evaluation of coverage of pelvis and inguinal\/femoral nodes. Int J Radiat Oncol Biol Phys. 2005;63:274\u201381.","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"455_CR23","doi-asserted-by":"publisher","first-page":"4581","DOI":"10.1200\/JCO.2007.12.0170","volume":"25","author":"JK Salama","year":"2007","unstructured":"Salama JK, Mell LK, Schomas DA, et al. Concurrent chemotherapy and intensity-modulated radiation therapy for anal canal cancer patients: a multicenter experience. J Clin Oncol. 2007;25:4581\u20136.","journal-title":"J Clin Oncol"}],"container-title":["Discover Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12672-021-00455-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s12672-021-00455-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12672-021-00455-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,4]],"date-time":"2021-12-04T04:34:05Z","timestamp":1638592445000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s12672-021-00455-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12]]},"references-count":23,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["455"],"URL":"https:\/\/doi.org\/10.1007\/s12672-021-00455-0","relation":{},"ISSN":["2730-6011"],"issn-type":[{"value":"2730-6011","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12]]},"assertion":[{"value":"3 August 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 November 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 December 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study protocol was approved by the Central Ethics Committee of The Sixth Affiliated Hospital, Sun Yat-sen University (Guangzhou, China) (No. 2020ZSLYEC-288).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"59"}}