Neoadjuvant Chemoradiation Improves Oncologic Outcomes in Low and Mid Clinical T3N0 Rectal Cancers

Overview

Journal Int J Colorectal Dis

Specialties Gastroenterology
General Surgery

Date 2019 Nov 29

PMID 31776698

Citations 2

Authors

Olga A Lavryk

Elena Manilich

Michael A Valente

Arshiya Miriam

Emre Gorgun

Matthew F Kalady

Sherief Shawki

Conor P Delaney

Scott R Steele

Affiliations

Soon will be listed here.

Abstract

Background: Controversial data exists in the current literature in regard to the use of neoadjuvant chemoradiation (nCRT) in patients with clinical T3N0 (cT3N0) rectal cancers, specifically based on location and relation to peritoneal reflection. We aimed to analyze the impact of nCRT on oncologic outcomes among cT3N0 rectal cancers, depending on the tumor height from anal verge (AV).

Methods: A retrospective analysis of patients with cT3N0 rectal cancers was included from a query of a prospectively maintained rectal cancer database from 1980 to 2016. Patients were divided into 3 groups based on the tumor height: low (1-5 cm from AV), mid (6-10 cm from AV), and upper (11-15 cm from AV). Patients were stratified by use of nCRT.

Main Outcomes: 5-year overall survival (OS), disease-free survival (DFS), cancer-specific survival (CSS), and local recurrence (LR) using Kaplan-Meier curves.

Results: Five hundred ninety-two patients were included. Overall, 364 (61.4%) patients received nCRT and 228 (38.6%) patients did not. There were 251 (43%) patients with low, 302 (51%) with mid, and 39 (7%) with upper rectal cancer. Patients with low and mid rectal cancers received nCRT more frequently than those with upper rectal cancers (68.5% and 61.2% vs 43.6%, p = 0.007). The 5-year OS was 78% and 63%, DFS-88% and 73%, LR-1% and 8% in nCRT followed by resection vs. surgery alone (p < 0.001). In regard to cancer location after nCRT compared with surgery alone, low and mid cancers had better OS, DFS, and CSS, compared with upper ones.

Conclusion: nCRT prolongs survival among patients with rectal cancer below 10 cm from AV; however, it has no effect on 5-year oncologic survival of patients with upper rectal cancer located below peritoneal reflection.

Citing Articles

Survival comparison of stage IIA rectal cancer with or without neoadjuvant therapy: a SEER database analysis with propensity score matching.

Yan H, Wang P, Wu Y, Liu Y J Gastrointest Oncol. 2022; 13(5):2293-2305.

PMID: 36388673 PMC: 9660043. DOI: 10.21037/jgo-22-166.

Effect of understaging on local recurrence of rectal cancer.

Giesen L, Borstlap W, Bemelman W, Tanis P, Verhoef C, Olthof P J Surg Oncol. 2020; 122(6):1179-1186.

PMID: 32654177 PMC: 7689834. DOI: 10.1002/jso.26111.

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