Adjuvant chemotherapy after preoperative (chemo)radiotherapy and surgery for patients with rectal cancer: a systematic review and meta-analysis of individual patient data

Breugom, A.J.; Swets, Marloes; Bosset, Jean-François; Collette, Laurence; Sainato, A.; Cionini, L.; Glynne‐Jones, Rob; Counsell, Nicholas; Bastiaannet, E.; Broek, C.B.M. van den; Liefers, Gerrit‐Jan; Putter, Hein; Velde, Cornelis J.H. van de

doi:10.1016/s1470-2045(14)71199-4

Cited by 506 publications

(312 citation statements)

References 37 publications

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“…The results of the present study suggested that neoadjuvant radiochemotherapy should be considered if the distance of tumor and the mesorectal fascia is predicted to be <1 mm by preoperative MRI in rectal cancer. While some recent studies have reported that postoperative treatment did not improve outcomes in this situation,28, 29, 30 we hypothesize that CRM could guide postoperative treatment in combination with preoperative MRI assessment and neoadjuvant chemotherapy 31, 32, 33. Also, the prognosis is typically better when the distance of the tumor is larger from the radial resection margin.…”

Section: Discussionmentioning

confidence: 81%

Circumferential resection margin as a prognostic factor after rectal cancer surgery: A large population‐based retrospective study

et al. 2018

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AimThis study aimed to investigate circumferential resection margin (CRM) as a prognostic factor for long‐term oncologic survival after rectal cancer surgery.MethodsPatients diagnosed with malignant rectal cancer between 1 January 2010 and 31 December 2014, from the Surveillance, Epidemiology, and End Results (SEER) program were identified for this study. The patients were divided into five CRM groups to compare the baseline characteristics and assess cancer‐specific survival (CSS): 0‐1 mm, 1.1‐2.0 mm, 2.1‐5.0 mm, 5.1‐10.0 mm, and >10 mm. The main endpoint was CSS.ResultsCircumferential resection margin ≤1 mm was independently associated with 99% increased risk of cancer‐specific mortality in rectal cancer [hazard ratio (HR) = 1.990, 95% confidence interval (CI) = 1.613‐2.454, P < 0.001, using CRM (1.1‐2.0 mm) as a reference]. CRM (5.1‐10.0 mm) was independently associated with 29.2% decreased risk of cancer‐specific mortality [HR = 0.708, 95% CI = 0.525‐0.954, P = 0.152, using group (2.1‐5.0 mm) as reference]. CRM ≤2 mm or ≤0.4 mm was not obviously associated with CSS.Conclusionscircumferential resection margin is an independent prognostic factor in rectal cancer. Surgeons should try to maximize the CRM. Rectal cancer patients with CRM ≤1 mm should receive more postoperative attention depending on individual situation. Also, CRM should be accurately measured in millimeters in a preoperative magnetic resonance imaging or pathological report, rather than simply described as “involved” or “clear.”

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Section: Discussionmentioning

confidence: 81%

Circumferential resection margin as a prognostic factor after rectal cancer surgery: A large population‐based retrospective study

et al. 2018

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“…Zwei der vier Studien mussten wegen schlechter Rekrutierung vorzeitig geschlossen werden und sind somit für die primären Endpunkte "underpowered" [1032,1033]. [1034]. Patienten mit ypTNM-Stadium 0-I nach neoadjuvanter Therapie waren aus dieser Metaanalyse allerdings ausgeschlossen, da sie in 2 der 4 Einzelstudien nicht inkludiert waren.…”

Section: Level Of Evidenceunclassified

S3-Leitlinie – Kolorektales Karzinom

Schmiegel

Buchberger

Follmann³

et al. 2017

Z Gastroenterol

148

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“…None of the trials were large enough to detect a 5% difference in 5year survival, hence the likelihood of type Ⅱ error was high [35] . As a result, Breugom et al [36] performed a metaanalysis of available studies using patientlevel data. Unfortunately, the authors were not able to obtain the data from the QUASAR trial investigators.…”

Section: Postoperative Chemotherapy After Neoadjuvant (Chemo)radiothementioning

confidence: 99%

“…Although this may reflect a real life scenario, it is pertinent to determine the effects of optimal chemotherapy treatment so that clinicians and patients can make the informed decision regarding the need for adjuvant chemotherapy. Breugom et al [34,36] argued that the results of the trials could have not been affected by poor adherence as PROCTORSCRIPT trial showed no benefit of chemotherapy for patients who completed all cycles. Unfortunately the number of patients in this group (n = 159) is too small to detect the clinically meaningful difference.…”

Section: Potential Pitfalls Of the Current Evidencementioning

confidence: 99%

“…In addition, surgery has been shown to enhance the production of oncogenic growth factors, such as transforming growth fact alpha [53,54] . Finally, the most informative analysis of these trials by Breugom et al [34,36] is not without limitations. Out of 2195 patients available from four trials, only 1196 were included.…”

Section: Potential Pitfalls Of the Current Evidencementioning

confidence: 99%

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Adjuvant chemotherapy for rectal cancer: Is it needed?

Milinis

Thornton

Montazeri

et al. 2015

WJCO

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Adjuvant chemotherapy has become a standard treatment of advanced rectal cancer in the West. The benefits of adjuvant chemotherapy after surgery alone have been well established. However, controversy surrounds the use adjuvant chemotherapy in patients who received preoperative chemoradiotherapy, despite it being recommended by a number of international guidelines. Results of recent multicentre randomised control trials showed no benefit of adjuvant chemotherapy in terms of survival and rates of distant metastases. However, concerns exist regarding the quality of the studies including inadequate staging modalities, out-dated chemotherapeutic regimens and surgical approaches and small sample sizes. It has become evident that not all the patients respond to adjuvant chemotherapy and more personalised approach should be employed when considering the benefits of adjuvant chemotherapy. The present review discusses the strengths and weaknesses of the current evidence-base and suggests improvements for future studies.

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Adjuvant chemotherapy after preoperative (chemo)radiotherapy and surgery for patients with rectal cancer: a systematic review and meta-analysis of individual patient data

Cited by 506 publications

References 37 publications

Circumferential resection margin as a prognostic factor after rectal cancer surgery: A large population‐based retrospective study

Circumferential resection margin as a prognostic factor after rectal cancer surgery: A large population‐based retrospective study

S3-Leitlinie – Kolorektales Karzinom

Adjuvant chemotherapy for rectal cancer: Is it needed?

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