Is There a Need for Neoadjuvant Short-course Radiotherapy in T3 Rectal Cancer with Positive Lymph Node Involvement? A Single-center Retrospective Cohort Study

Overview

Journal World J Surg Oncol

Publisher Biomed Central

Specialties General Surgery
Oncology

Date 2019 Aug 10

PMID 31395058

Citations 7

Authors

Minna Rasanen

Laura Renkonen-Sinisalo

Harri Mustonen

Anna Lepisto

Affiliations

Soon will be listed here.

Abstract

Background: Neoadjuvant short-course radiotherapy is used to reduce local recurrences in stage III rectal cancer. Radiotherapy is not harmless, and meticulous total mesorectal excision surgery alone has been reported to result in low local recurrence rate in favorable stage III tumors. The aim was to evaluate the effect of short-course (5 × 5 Gy) radiotherapy on the local recurrence risk in patients with pT3N1-2 rectal cancer.

Materials And Methods: This was a retrospective study with 151 consecutive pT3N1-2M0 rectal cancer patients operated on at Helsinki University Hospital, Helsinki, Finland, during January 2005 to June 2014. Short-course radiotherapy was given to 94 patients, and 57 patients were operated on without neoadjuvant radiotherapy. The main outcome measurement was the effect of radiotherapy on local recurrence. Also, the risk factors for local recurrence were analyzed.

Results: Local recurrence occurred in a total 17 of 151 (11.3%) patients, 8 of 57 (14.0%) in surgery only group compared with 9 of 94 (9.6%) in radiotherapy plus surgery group (p = 0.44). In univariate Cox regression analysis, the risk factors for local recurrence were tumor location under 6 cm from the anal verge (p = 0.01), involved lateral margin (p < 0.001), tumor perforation (p < 0.001), and mucinous histology (p = 0.006). In multivariate analysis, risk factors were tumor location under 6 cm from anal verge (p = 0.03) and involved lateral margin (p = 0.002).

Conclusion: Neoadjuvant short-course radiotherapy did not affect the local recurrence risk of pT3N1-2M0 rectal cancer. Further studies with larger patient number are needed to evaluate the role of short-course radiotherapy in different T3 subgroups (3a-c) as well as in N1 and N2 cancers in separate.

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Histogram Analysis of Diffusion-Weighted Magnetic Resonance Imaging as a Biomarker to Predict Lymph Node Metastasis in T3 Stage Rectal Carcinoma.

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References

Kapiteijn E, Marijnen C, Nagtegaal I, Putter H, Steup W, Wiggers T . Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001; 345(9):638-46. DOI: 10.1056/NEJMoa010580. View

Merkel S, Mansmann U, Siassi M, Papadopoulos T, Hohenberger W, Hermanek P . The prognostic inhomogeneity in pT3 rectal carcinomas. Int J Colorectal Dis. 2001; 16(5):298-304. DOI: 10.1007/s003840100309. View

Kapiteijn E, Putter H, van de Velde C . Impact of the introduction and training of total mesorectal excision on recurrence and survival in rectal cancer in The Netherlands. Br J Surg. 2002; 89(9):1142-9. DOI: 10.1046/j.1365-2168.2002.02196.x. View

Matthiessen P, Hallbook O, Andersson M, Rutegard J, Sjodahl R . Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis. 2004; 6(6):462-9. DOI: 10.1111/j.1463-1318.2004.00657.x. View

Marijnen C, van de Velde C, Putter H, van den Brink M, Maas C, Martijn H . Impact of short-term preoperative radiotherapy on health-related quality of life and sexual functioning in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol. 2005; 23(9):1847-58. DOI: 10.1200/JCO.2005.05.256. View

Folkesson J, Birgisson H, Pahlman L, Cedermark B, Glimelius B, Gunnarsson U . Swedish Rectal Cancer Trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol. 2005; 23(24):5644-50. DOI: 10.1200/JCO.2005.08.144. View

Birgisson H, Pahlman L, Gunnarsson U, Glimelius B . Occurrence of second cancers in patients treated with radiotherapy for rectal cancer. J Clin Oncol. 2005; 23(25):6126-31. DOI: 10.1200/JCO.2005.02.543. View

Burton S, Brown G, Daniels I, Norman A, Mason B, Cunningham D . MRI directed multidisciplinary team preoperative treatment strategy: the way to eliminate positive circumferential margins?. Br J Cancer. 2006; 94(3):351-7. PMC: 2361145. DOI: 10.1038/sj.bjc.6602947. View

Bujko K, Nowacki M, Nasierowska-Guttmejer A, Michalski W, Bebenek M, Kryj M . Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg. 2006; 93(10):1215-23. DOI: 10.1002/bjs.5506. View

10.

Eriksen M, Wibe A, Haffner J, Wiig J . Prognostic groups in 1,676 patients with T3 rectal cancer treated without preoperative radiotherapy. Dis Colon Rectum. 2006; 50(2):156-67. DOI: 10.1007/s10350-006-0757-1. View

11.

Peeters K, Marijnen C, Nagtegaal I, Kranenbarg E, Putter H, Wiggers T . The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg. 2007; 246(5):693-701. DOI: 10.1097/01.sla.0000257358.56863.ce. View

12.

Sebag-Montefiore D, Stephens R, Steele R, Monson J, Grieve R, Khanna S . Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet. 2009; 373(9666):811-20. PMC: 2668947. DOI: 10.1016/S0140-6736(09)60484-0. View

13.

Parc Y, Zutshi M, Zalinski S, Ruppert R, Furst A, Fazio V . Preoperative radiotherapy is associated with worse functional results after coloanal anastomosis for rectal cancer. Dis Colon Rectum. 2009; 52(12):2004-14. DOI: 10.1007/DCR.0b013e3181beb4d8. View

14.

Kusters M, Marijnen C, van de Velde C, Rutten H, Lahaye M, Kim J . Patterns of local recurrence in rectal cancer; a study of the Dutch TME trial. Eur J Surg Oncol. 2010; 36(5):470-6. DOI: 10.1016/j.ejso.2009.11.011. View

15.

Stephens R, Thompson L, Quirke P, Steele R, Grieve R, Couture J . Impact of short-course preoperative radiotherapy for rectal cancer on patients' quality of life: data from the Medical Research Council CR07/National Cancer Institute of Canada Clinical Trials Group C016 randomized clinical trial. J Clin Oncol. 2010; 28(27):4233-9. DOI: 10.1200/JCO.2009.26.5264. View

16.

Taylor F, Quirke P, Heald R, Moran B, Blomqvist L, Swift I . Preoperative high-resolution magnetic resonance imaging can identify good prognosis stage I, II, and III rectal cancer best managed by surgery alone: a prospective, multicenter, European study. Ann Surg. 2011; 253(4):711-9. DOI: 10.1097/SLA.0b013e31820b8d52. View

17.

van Gijn W, Marijnen C, Nagtegaal I, Meershoek-Klein Kranenbarg E, Putter H, Wiggers T . Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol. 2011; 12(6):575-82. DOI: 10.1016/S1470-2045(11)70097-3. View

18.

Bernstein T, Endreseth B, Romundstad P, Wibe A . Improved local control of rectal cancer reduces distant metastases. Colorectal Dis. 2012; 14(10):e668-78. DOI: 10.1111/j.1463-1318.2012.03089.x. View

19.

Sterzing F, Hoehle F, Ulrich A, Jensen A, Debus J, Muenter M . Clinical results and toxicity for short-course preoperative radiotherapy and total mesorectal excision in rectal cancer patients. J Radiat Res. 2014; 56(1):169-76. PMC: 4572597. DOI: 10.1093/jrr/rru089. View

20.

van den Broek C, van Gijn W, Bastiaannet E, Moller B, Johansson R, Elferink M . Differences in pre-operative treatment for rectal cancer between Norway, Sweden, Denmark, Belgium and the Netherlands. Eur J Surg Oncol. 2014; 40(12):1789-96. DOI: 10.1016/j.ejso.2014.09.011. View