The British journal of radiology · 2026
A Systematic Review and Meta-Analysis of Inguinal Node Relapse Risk in Anal Squamous Cell Carcinoma Following Chemoradiotherapy Omitting Prophylactic Inguinal Node Irradiation.
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Harrison James, Oke Jason, Goh Vicky, Muirhead Rebecca
Аннотация
OBJECTIVES: 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.
METHODS: A systematic literature review was performed in accordance with the PRISMA standards using using Scopus, Embase, Cochrane Library and Pubmed for relevant studies between 1980 and 2025. Studies of > 10 patients treated with chemoradiotherapy without PINI and a minimum FU of 24 months were included. Data on stage, recurrence, staging investigations, and radiotherapy technique was extracted and analysed.
RESULTS: Nine papers 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 papers 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 tumours respectively were 2.20% (95% CI 0.5-8.3) and 8.7 (95% CI 5.4-13.7).
CONCLUSIONS: The quantification of inguinal relapse rates supports existing clinical practise that in selected patients, with T1 tumours or the frail and co-morbid population, it may be appropriate to omit PINI.
ADVANCES IN KNOWLEDGE: 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 tumours may be an alternative strategy and should be investigated further in clinical trials.
METHODS: A systematic literature review was performed in accordance with the PRISMA standards using using Scopus, Embase, Cochrane Library and Pubmed for relevant studies between 1980 and 2025. Studies of > 10 patients treated with chemoradiotherapy without PINI and a minimum FU of 24 months were included. Data on stage, recurrence, staging investigations, and radiotherapy technique was extracted and analysed.
RESULTS: Nine papers 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 papers 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 tumours respectively were 2.20% (95% CI 0.5-8.3) and 8.7 (95% CI 5.4-13.7).
CONCLUSIONS: The quantification of inguinal relapse rates supports existing clinical practise that in selected patients, with T1 tumours or the frail and co-morbid population, it may be appropriate to omit PINI.
ADVANCES IN KNOWLEDGE: 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 tumours may be an alternative strategy and should be investigated further in clinical trials.