Would you offer radiation for suspected retroperitoneal nodal metastases in a patient with metastatic colorectal cancer with a single liver metastasis who had an excellent response to neoadjuvant chemotherapy?
This is a patient with stage IV T3 N1 M1 MSI stable adenocarcinoma of the rectosigmoid junction who presented with small volume upper retroperitoneal adenopathy and one definite biopsy-proven right segment 7 liver metastasis on PET staging. Had excellent response to FOLFOX, particularly in the liver, less so otherwise. Plan is pre-op RT to primary, then LAR and microwave ablation to liver lesion. Is there any role for radiation to the small group of RP nodes with IMRT, not ideal for SBRT or resection? If so, would one use the involved field only and what dose fractionation? Or is treating RP nodes unlikely to impact outcome and risk undue toxicity?
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Would you offer radiation for suspected RP nodal mets in patient with CRC with a single liver metastasis who had an excellent response to neoadjuvant chemo?
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1 Answer
Mednet MemberInvited Expert
Radiation Oncology · Memorial Sloan-Kettering Cancer Center
Answered on
Yes, in the setting of all other disease likely controlled and response to systemic, the control of the RP nodes (gross and microscopic) should be considered definitive and curative. RP/PA nodes should be considered N2 rather than M1. As such, elective nodal RT should also be given with IMRT, not SB...
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