Adjuvant chemotherapy for rectal cancer patients treated with preoperative (chemo)radiotherapy and total mesorectal excision: a Dutch Colorectal Cancer Group (DCCG) randomized phase III trial

Breugom, A.J.; Gijn, W. van; Müller, E; Berglund, Åke; Broek, C.B.M. van den; Fokstuen, Tone; Gelderblom, Hans; Kapiteijn, Ellen; Leer, J.W.H.; Marijnen, Corrie A.M.; Martijn, Hendrik; Kranenbarg, Elma Meershoek-Klein; Nagtegaal, Irıs D.; Påhlman, Lars; Punt, Cornelis J.A.; Putter, Hein; Roodvoets, Annet G.H.; Rutten, H.J.T.; Steup, W. H.; Glimelius, Bengt; Velde, Cornelis J.H. van de

doi:10.1093/annonc/mdu560

Cited by 323 publications

(243 citation statements)

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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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“…Dies gilt insbesondere für Studien, bei denen die Randomisierung vor neoadjuvanter Behandlung und Operation erfolgte [959,1031]. Zwei der vier Studien mussten wegen schlechter Rekrutierung vorzeitig geschlossen werden und sind somit für die primären Endpunkte "underpowered" [1032,1033]. [1034].…”

Section: Level Of Evidenceunclassified

S3-Leitlinie – Kolorektales Karzinom

Schmiegel

Buchberger

Follmann³

et al. 2017

Z Gastroenterol

146

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“…However, a more recent meta-analysis of four trials which included preoperative radiotherapy, questions the benefit of postoperative AC (HR for DFS 0·91, CI 0·77-1·07; p=0·230), although only 75 of 1196 patients included in the report had oxaliplatin in addition to a fluoropyrimidine. [41] Many individuals exhibit poor tolerance of this package of treatment due to morbidity from radiotherapy and pelvic surgery resulting in failure to start AC or dose reductions [42]. Of 506 rectal cancer patients due to receive AC post LCPCRT in one study, only 43% tolerated the full course and 27% never started treatment [4,42].…”

Section: Rationale For Neoadjuvant Chemotherapy In Rectal Cancermentioning

confidence: 99%

Neoadjuvant Treatment Strategies for Locally Advanced Rectal Cancer

Gollins

Sebag‐Montefiore

2016

Clinical Oncology

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Improved surgical technique plus selective pre-operative radiotherapy, has decreased rectal cancer pelvic local recurrence (LR) from historically 25%, down to approximately 5-10%. However, this improvement has not reduced distant metastatic relapse, the main cause of death and a key issue in rectal cancer management.The current standard is local pelvic treatment (surgery +/-pre-operative radiotherapy) followed by adjuvant chemotherapy (AC), depending on resection histology. For circumferential resection margin (CRM)-threatened cancer on baseline MRI, downstaging long-course pre-operative chemoradiation (LCPCRT) is generally used. However, for non-CRM threatened disease, varying approaches are currently adopted in the UK, including straight to surgery (STS), short-course pre-operative radiotherapy (SCPRT) and LCPCRT.Clinical trials are investigating intensification of concurrent chemoradiation. There is also increasing interest in investigating pre-operative neoadjuvant chemotherapy (NAC) as a way of exposing micro-metastatic disease to full dose systemic chemotherapy as early as possible and potentially reducing metastatic relapse.Phase II trials suggest that this strategy is feasible, with promising histological response and low rates of tumour progression during NAC. Phase III trials are needed to determine the benefit of NAC when added to standard therapy and also to determine if it can be used instead of neoadjuvant radiotherapy based schedules.

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Adjuvant chemotherapy for rectal cancer patients treated with preoperative (chemo)radiotherapy and total mesorectal excision: a Dutch Colorectal Cancer Group (DCCG) randomized phase III trial

Abstract: Dutch Colorectal Cancer group, CKTO 2003-16, ISRCTN36266738.

Cited by 323 publications

References 24 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

Neoadjuvant Treatment Strategies for Locally Advanced Rectal Cancer

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