The Results and Outcomes of Rectal Cancer Treatment in the Era of Adjuvant Chemoradiation

Document Type : Research/Original Article

Authors

1 Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran

2 Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

3 University of Kufa, College of medicine, Kufa, Iraq

4 Department of Radiation Oncology, Shiraz University of Medical Sciences, Shiraz, Iran

Abstract

Abstract
Background: Colorectal cancer causes many deaths worldwide and rectal cancer includes one-third of them. Surgical mesorectal excision along with preoperative neoadjuvant chemoradiotherapy is known as the standard treatment for rectal cancer. However, inaccurate preoperative staging is a main concern which leads to large number of patients not being treated with neoadjuvant therapy. Selection of the best treatment approach for these patients is controversial. Although significant better survival was observed is patients who received postoperative adjuvant chemoradiation compared with patients who treated with surgery alone, other studies did not find such results. Due to these contradictory results, this study was designed to further evaluate the survival outcomes in rectal cancer patients who received adjuvant chemoradiotherapy without neoadjuvant therapy. Methods: Totally 197 rectal cancer patients who received adjuvant chemoradiation were included in this study. The demographic and clinico-pathological characteristics of the patients were evaluated by statistical analysis. Results: Based on the univariate cox regression, poor disease free survival (DFS) was significantly associated with male sex and T3 stage. Poor overall survival (OS) was also associated with stage II/III, T3/T4, NI/NII, grade II/III, positive node number (> 3), perineural invasion, lymphovascular invasion, and margin involvement. According to the multivariate cox regression, independent predictive factors for DFS were T3 andT4 stage, and for OS were also T3/ T4 stage, grade II/ III and lymphovascular invasion. Conclusions: Taken together, obtained results indicated that combined adjuvant chemoradiation contributes to improve survival outcomes in the rectal cancer patients who did not received neoadjuvant therapy.

Keywords

References

1.            Glimelius B, Grönberg H, Järhult J, Wallgren A, Cavallin-Staahl E. A systematic overview of radiation therapy effects in rectal cancer. Acta oncologica. 2003;42(5-6):476-92.
2.            Song C, Song S, Kim J-S, Oh H-K, Kim D-W, Lee K-W, et al. Impact of postoperative chemoradiotherapy versus chemotherapy alone on recurrence and survival in patients with Stage II and III Upper Rectal Cancer: A Propensity Score-Matched Analysis. PloS one. 2015;10(4):e0123657.
3.            Huang Yx, Lin Yz, Li Jl, Zhang Xq, Tang Lr, Zhuang Qy, et al. Role of postoperative radiotherapy in pT3N0 rectal cancer: A risk‐stratification system based on population analyses. Cancer medicine. 2019.
4.            Yu D, Wang Y, Song Y, Gao P, Sun J, Chen X, et al. The efficacy of postoperative radiotherapy for locally advanced rectal cancer without neoadjuvant therapy. Translational Cancer Research. 2018;7(4):922-35.
5.            Barton MK. Delivery of neoadjuvant chemoradiation for patients with stage II and III rectal cancer is suboptimal. CA: a cancer journal for clinicians. 2016;66(5):357-8.
6.            Sineshaw HM, Jemal A, Thomas Jr CR, Mitin T. Changes in treatment patterns for patients with locally advanced rectal cancer in the United States over the past decade: An analysis from the National Cancer Data Base. Cancer. 2016;122(13):1996-2003.
7.            Rectal cancer V.1. NCCN Clinical Practical Guidelines in Oncology 2015 [
8.            Glynne-Jones R, Wyrwicz L, Tiret E, Brown G, Rödel C, Cervantes A, et al. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. 2017.
9.            Peng LC, Milsom J, Garrett K, Nandakumar G, Coplowitz S, Parashar B, et al. Surveillance, epidemiology, and end results-based analysis of the impact of preoperative or postoperative radiotherapy on survival outcomes for T3N0 rectal cancer. Cancer epidemiology. 2014;38(1):73-8.
10.          Kim JS, Kim NK, Min BS, Hur H, Ahn JB, Keum KC. Adjuvant radiotherapy following total mesorectal excision for stage IIA rectal cancer: is it beneficial? International journal of colorectal disease. 2010;25(9):1103-10.
11.          Komori K, Kimura K, Kinoshita T, Sano T, Ito S, Abe T, et al. Complications associated with postoperative adjuvant radiation therapy for advanced rectal cancer. International surgery. 2014;99(2):100-5.
12.          Vignali A, De Nardi P. Multidisciplinary treatment of rectal cancer in 2014: where are we going? World journal of gastroenterology: WJG. 2014;20(32):11249.
13.          Gunderson LL, Jessup JM, Sargent DJ, Greene FL, Stewart AK. Revised TN categorization for colon cancer based on national survival outcomes data. Journal of clinical oncology. 2010;28(2):264.
14.          Group CCC. Adjuvant radiotherapy for rectal cancer: a systematic overview of 8507 patients from 22 randomised trials. The Lancet. 2001;358(9290):1291-304.
15.          MacFarlane J, Ryall R, Heald R. Mesorectal excision for rectal cancer. The lancet. 1993;341(8843):457-60.
16.          Enker WE, Thaler HT, Cranor ML, Polyak T. Total mesorectal excision in the operative treatment of carcinoma of the rectum. Journal of the American College of Surgeons. 1995;181(4):335-46.
17.          Kang BM, Baek J-H, Park SJ, Baek SK, Park K-J, Choi H-J, et al. Impact of adjuvant therapy type on survival in stage II/III rectal cancer without preoperative chemoradiation: a Korean multicenter retrospective study. Annals of coloproctology. 2018;34(3):144.
18.          Kim CK, Kim SH, Chun HK, Lee W-Y, Yun S-H, Song S-Y, et al. Preoperative staging of rectal cancer: accuracy of 3-Tesla magnetic resonance imaging. European radiology. 2006;16(5):972-80.
19.          Group GTS. Prolongation of the disease-free interval in surgically treated rectal carcinoma. New England Journal of Medicine. 1985;312(23):1465-72.
20.          Krook JE, Moertel CG, Gunderson LL, Wieand HS, Collins RT, Beart RW, et al. Effective surgical adjuvant therapy for high-risk rectal carcinoma. New England Journal of Medicine. 1991;324(11):709-15.
21.          Tveit KM, Guldvog I, Hagen S, Trondsen E, Harbitz T, Nygaard K, et al. Randomized controlled trial of postoperative radiotherapy and short‐term time‐scheduled 5‐fluorouracil against surgery alone in the treatment of Dukes B and C rectal cancer. British Journal of Surgery. 1997;84(8):1130-5.
22.          Milinis K, Thornton M, Montazeri A, Rooney PS. Adjuvant chemotherapy for rectal cancer: Is it needed? World journal of clinical oncology. 2015;6(6):225.
Iranian Journal of Colorectal Research
Volume 7, Issue 4
December 2019
Pages 1-6

Files

Share

How to cite

Statistics