{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T02:38:48Z","timestamp":1792636728683,"version":"4.5.0"},"reference-count":29,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"am","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Prophylactic inguinal node irradiation (PINI) is standard in chemoradiotherapy for anal squamous cell carcinoma. However, PINI increases toxicity, including bowel and sexual dysfunction, bone marrow suppression, and lymphoedema. Evidence on inguinal node relapse risk without PINI remains limited, warranting systematic review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic literature review was performed in accordance with the PRISMA standards using Scopus, Embase, Cochrane Library, and Pubmed for relevant studies between 1980 and 2025. Studies of &amp;gt;10 patients treated with chemoradiotherapy without PINI and a minimum FU of 24\u2009months were included. Data on stage, recurrence, staging investigations, and radiotherapy technique was extracted and analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Nine articles were identified satisfying predefined inclusion and exclusion criteria, included 727 patients. All 9 reported individual outcomes for stages grouped as T1\/2 and T3\/4, 6 articles detailed outcomes for individual stages. The pooled estimated risk of lymph node relapse in T1\/2 patients is 8.0% (95% CI, 6.0-10.6). The pooled analysis for T1 and T2 tumors, respectively, were 2.20% (95% CI, 0.5-8.3) and 8.7 (95% CI, 5.4-13.7).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The quantification of inguinal relapse rates supports existing clinical practice that in selected patients, with T1 tumors or the frail and co-morbid population, it may be appropriate to omit PINI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Advances in knowledge<\/jats:title>\n                    <jats:p>Following the recently published ACT4 study, suggesting that reduction of dose does not reduce morbidity, this research suggests that exclusion of inguinal nodes in early-stage tumors may be an alternative strategy and should be investigated further in clinical trials<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjr\/tqag248","type":"journal-article","created":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T06:07:38Z","timestamp":1791871658000},"source":"Crossref","is-referenced-by-count":0,"title":["A systematic review and meta-analysis of inguinal node relapse risk in anal squamous cell carcinoma following chemoradiotherapy omitting prophylactic inguinal node irradiation"],"prefix":"10.1093","author":[{"given":"James","family":"Harrison","sequence":"first","affiliation":[{"name":"St. Anne\u2019s College, University of Oxford , Oxford, OX2 6HS,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Oke","sequence":"additional","affiliation":[{"name":"Centre for Evidence-Based Medicine, University of Oxford , Oxford, OX2 6GG,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2321-8091","authenticated-orcid":false,"given":"Vicky","family":"Goh","sequence":"additional","affiliation":[{"name":"School of Biomedical Engineering and Imaging Sciences, King\u2019s College London , London, SE1 7EU,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1124-7549","authenticated-orcid":false,"given":"Rebecca","family":"Muirhead","sequence":"additional","affiliation":[{"name":"Department of Oncology, Oxford University Hospitals NHS Foundation Trust , Oxford, OX3 7DQ,","place":["United Kingdom"]},{"name":"Department of Oncology, University of Oxford , Oxford, OX3 7LE,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"2026102121520751600_tqag248-B1","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1016\/S1470-2045(13)70086-X","article-title":"Mitomycin or cisplatin chemoradiation with or without maintenance chemotherapy for treatment of squamous-cell carcinoma of the anus (ACT II): a randomised, phase 3, open-label, 2\u2009\u00d7\u20092 factorial trial","volume":"14","author":"James","year":"2013","journal-title":"Lancet Oncol"},{"key":"2026102121520751600_tqag248-B2","doi-asserted-by":"publisher","first-page":"1427","DOI":"10.1080\/0284186X.2018.1503713","article-title":"Late gastrointestinal toxicity after radiotherapy for anal cancer: a systematic literature review","volume":"57","author":"Pan","year":"2018","journal-title":"Acta Oncol"},{"key":"2026102121520751600_tqag248-B3","doi-asserted-by":"publisher","first-page":"1688","DOI":"10.1080\/0284186X.2021.1983208","article-title":"Management of late adverse effects after chemoradiation for anal cancer","volume":"60","author":"Haas","year":"2021","journal-title":"Acta Oncol"},{"key":"2026102121520751600_tqag248-B4","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1016\/S1470-2045(25)00213-X","article-title":"Standard versus reduced-dose chemoradiotherapy in anal cancer (PLATO-ACT4): short-term results of a phase 2 randomised controlled trial","volume":"26","author":"Gilbert","year":"2025","journal-title":"Lancet Oncol"},{"key":"2026102121520751600_tqag248-B5","doi-asserted-by":"publisher","first-page":"S1246","DOI":"10.1016\/S0167-8140(25)01871-7","article-title":"PLATO ACT 4: long term results of an RCT evaluating reduced dose and standard dose chemoradiotherapy in early-stage anal cancer (ISRCTN : 88455282)","volume":"206","author":"Sebag-Montefiore","year":"2025","journal-title":"Radiother Oncol"},{"key":"2026102121520751600_tqag248-B6","doi-asserted-by":"publisher","first-page":"104770","DOI":"10.1016\/j.canrad.2025.104770","article-title":"Role of radiotherapy in the management of anal canal cancer: recommendations of the soci\u00e9t\u00e9 fran\u00e7aise de radioth\u00e9rapie oncologique","volume":"29","author":"Raynaud","year":"2025","journal-title":"Cancer Radiother"},{"key":"2026102121520751600_tqag248-B7","doi-asserted-by":"publisher","first-page":"e109655","DOI":"10.1136\/bmjopen-2025-109655","article-title":"Personalising anal cancer radiotherapy dose (PLATO): protocol for a multicentre integrated platform trial","volume":"15","author":"Frood","year":"2025","journal-title":"BMJ Open"},{"key":"2026102121520751600_tqag248-B8","doi-asserted-by":"publisher","first-page":"897","DOI":"10.1080\/0284186X.2023.2240490","article-title":"Nordic anal cancer (NOAC) group consensus guidelines for risk-adapted delineation of the elective clinical target volume in anal cancer","volume":"62","author":"Nilsson","year":"2023","journal-title":"Acta Oncol"},{"key":"2026102121520751600_tqag248-B9","doi-asserted-by":"publisher","first-page":"S1166","DOI":"10.1016\/S0167-8140(25)00455-4","article-title":"1435 de\u2011escalating Anal Cancer (DeACT) in co\u2011morbid and frail patients: a retrospective UK national service evaluation","volume":"206","author":"Sinclair","year":"2025","journal-title":"Radiotherapy and Oncology"},{"key":"2026102121520751600_tqag248-B10","doi-asserted-by":"publisher","first-page":"110788","DOI":"10.1016\/j.radonc.2025.110788","article-title":"Elective clinical target volume in early squamous cell anal canal cancer: a systematic review and meta-analysis of the risk of recurrence in untreated upper pelvic and external iliac lymph nodes","volume":"206","author":"Socha","year":"2025","journal-title":"Radiother Oncol"},{"key":"2026102121520751600_tqag248-B11","author":"Robinson","year":"2026"},{"key":"2026102121520751600_tqag248-B12","author":"Renehan","year":"2026"},{"key":"2026102121520751600_tqag248-B13","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"2026102121520751600_tqag248-B14","doi-asserted-by":"publisher","first-page":"108602","DOI":"10.1016\/j.envint.2024.108602","article-title":"A tool to assess risk of bias in non-randomized follow-up studies of exposure effects (ROBINS-E)","volume":"186","author":"Higgins","year":"2024","journal-title":"Environ Int"},{"key":"2026102121520751600_tqag248-B15","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v036.i03","article-title":"Conducting meta-analyses in R with the metafor package","volume":"36","author":"Viechtbauer","year":"2010","journal-title":"J Stat Software"},{"key":"2026102121520751600_tqag248-B16","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1002\/1097-0142(20010701)92:1&lt;77::AID-CNCR1294&gt;3.0.CO;2-P","article-title":"Management of inguinal lymph node metastases in patients with carcinoma of the anal canal: experience in a series of 270 patients treated in Lyon and review of the literature","volume":"92","author":"Gerard","year":"2001","journal-title":"Cancer"},{"key":"2026102121520751600_tqag248-B17","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1016\/j.clon.2009.01.015","article-title":"Size does matter: can we reduce the radiotherapy field size for selected cases of anal canal cancer undergoing chemoradiation?","volume":"21","author":"Crowley","year":"2009","journal-title":"Clin Oncol (R Coll Radiol)"},{"key":"2026102121520751600_tqag248-B18","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1016\/j.radonc.2010.10.005","article-title":"T1-2 anal carcinoma requires elective inguinal radiation treatment\u2014the results of trans-Tasman radiation oncology group study TROG 99.02","volume":"98","author":"Matthews","year":"2011","journal-title":"Radiother Oncol"},{"key":"2026102121520751600_tqag248-B19","doi-asserted-by":"publisher","first-page":"552","DOI":"10.1016\/j.ijrobp.2011.07.007","article-title":"Twenty-five-year experience with radical chemoradiation for anal cancer","volume":"83","author":"Tomaszewski","year":"2012","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"2026102121520751600_tqag248-B20","doi-asserted-by":"publisher","first-page":"1988","DOI":"10.1016\/j.ijrobp.2011.02.010","article-title":"Anal canal cancer: management of inguinal nodes and benefit of prophylactic inguinal irradiation (CORS-03 study)","volume":"82","author":"Ortholan","year":"2012","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"2026102121520751600_tqag248-B21","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1016\/j.ijrobp.2013.03.008","article-title":"Elective inguinal node irradiation in early-stage T2N0 anal cancer: prognostic impact on locoregional control","volume":"87","author":"Zilli","year":"2013","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"2026102121520751600_tqag248-B22","doi-asserted-by":"publisher","first-page":"578","DOI":"10.1097\/DCR.0000000000000050","article-title":"Inguinal lymph node recurrence in the untreated groin of patients with anal carcinoma","volume":"57","author":"Blinde","year":"2014","journal-title":"Dis Colon Rectum"},{"key":"2026102121520751600_tqag248-B23","doi-asserted-by":"publisher","first-page":"83","DOI":"10.3857\/roj.2015.33.2.83","article-title":"Can we omit prophylactic inguinal nodal irradiation in anal cancer patients?","volume":"33","author":"Kim","year":"2015","journal-title":"Radiat Oncol J"},{"key":"2026102121520751600_tqag248-B24","doi-asserted-by":"publisher","first-page":"870","DOI":"10.1111\/ans.14398","article-title":"Radiotherapy for anal squamous cell carcinoma: must the upper pelvic nodes and the inguinal nodes be treated?","volume":"88","author":"Thompson","year":"2018","journal-title":"ANZ J Surg"},{"key":"2026102121520751600_tqag248-B25","doi-asserted-by":"publisher","first-page":"1348","DOI":"10.1016\/S1470-2045(17)30456-4","article-title":"Nodal stage migration and prognosis in anal cancer: a systematic review, meta-regression, and simulation study","volume":"18","author":"Sekhar","year":"2017","journal-title":"Lancet Oncol"},{"key":"2026102121520751600_tqag248-B26","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1111\/1754-9485.70071","article-title":"Diagnostic and therapeutic impact of FDG-PET\/CT following MRI staging in anal cancer: a systematic review and meta-analysis","volume":"70","author":"Temperley","year":"2026","journal-title":"J Med Imaging Radiat Oncol"},{"key":"2026102121520751600_tqag248-B27","volume-title":"Clinical Radiation Oncology","author":"Gunderson","year":"2025","edition":"4th"},{"key":"2026102121520751600_tqag248-B28","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1159\/000348387","article-title":"Dosimetric parameters predictive of acute gastrointestinal toxicity in patients with anal carcinoma treated with concurrent chemotherapy and intensity-modulated radiation therapy","volume":"85","author":"DeFoe","year":"2013","journal-title":"Oncology"},{"key":"2026102121520751600_tqag248-B29","doi-asserted-by":"publisher","first-page":"102812","DOI":"10.1016\/j.jgo.2025.102812","article-title":"Important aspects of care and priorities of older patients with cancer: the PRIORITY multicenter cohort study","volume":"17","author":"Grellety","year":"2026","journal-title":"J Geriatr Oncol"}],"container-title":["British Journal of Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/bjr\/advance-article-pdf\/doi\/10.1093\/bjr\/tqag248\/71892503\/tqag248.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjr\/advance-article-pdf\/doi\/10.1093\/bjr\/tqag248\/71892503\/tqag248.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T01:52:11Z","timestamp":1792633931000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjr\/advance-article\/doi\/10.1093\/bjr\/tqag248\/8911839"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,12]]},"references-count":29,"URL":"https:\/\/doi.org\/10.1093\/bjr\/tqag248","relation":{},"ISSN":["0007-1285","1748-880X"],"issn-type":[{"value":"0007-1285","type":"print"},{"value":"1748-880X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,12]]},"article-number":"tqag248"}}