Analysis of clinical outcomes and prognostic factors of neoadjuvant chemoradiotherapy combined with surgery: intraperitoneal versus extraperitoneal rectal cancer

Benzoni, Enrico; Terrosu, Giovanni; Bresàdola, Vittorio; Cerato, F.; Cojutti, Alessandro; Milan, Elisa; Dado, G.; Bresadola, F

doi:10.1111/j.1365-2354.2006.00653.x

Cited by 27 publications

(17 citation statements)

References 19 publications

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“…Different tumor biologies, the technical difficulties of the surgical procedures, and the administration of adjuvant treatment in extraperitoneal rectal cancer [9,10,18,19] suggest the need for studies that focus on the CRM statuses of patients with 'wholly' extraperitoneal rectal cancer. From a technical and anatomical perspective, it is more difficult to achieve a clear CRM for extraperitoneal tumors.…”

Section: Discussionmentioning

confidence: 99%

Risk factors of circumferential resection margin involvement in the patients with extraperitoneal rectal cancer

Shin

2012

J Korean Surg Soc

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PurposeCurrently, circumferential resection margins (CRM) are used as a clinical endpoint in studies on the prognosis of rectal cancer. Although the concept of a circumferential resection margin in extraperitoneal rectal cancer differs from that in intraperitoneal rectal cancer due to differences in anatomical and biologic behaviors, previous reports have provided information on CRM involvement in all types of rectal cancer including intraperitoneal lesions. Therefore, the aim of this study was to analyze risk factors of CRM involvement in extraperitoneal rectal cancer.MethodsFrom January 2005 to December 2008, 306 patients with extraperitoneal rectal cancer were enrolled in a prospectively collected database. Multivariate logistic regression analysis was used to identify predictors of CRM involvement.ResultsThe overall rate of CRM involvement was found to be 16.0%. Multivariate analysis showed that male sex, larger tumor size (≥4 cm), stage higher than T3, nodal metastasis, tumor perforation and non-sphincter preserving proctectomy (NSPP) were risk factors for CRM involvement.ConclusionMale sex, larger tumor size (≥4 cm), advanced T stage, nodal metastasis, tumor perforation, and NSPP are significant risk factors of CRM involvement in extraperitoneal rectal cancer. Given that postoperative chemoradiotherapy is recommended for patients with a positive CRM, further oncologic studies are warranted to ascertain which patients with these risk factors would require adjuvant therapy.

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Section: Discussionmentioning

confidence: 99%

Risk factors of circumferential resection margin involvement in the patients with extraperitoneal rectal cancer

Shin

2012

J Korean Surg Soc

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“…The peritoneal reflection is a landmark used for evaluating the rectum anteriorly, and divides the rectum into two parts, that is, the intraperitoneal and extraperitoneal regions, which are referred to considerations of the venous and lymphatic drainage systems of the rectum 2. In particular, extraperitoneal rectal tumours disseminate mainly through the systemic pelvic venous and lateral lymphatic drainage systems, whereas intraperitoneal rectal tumours disseminate mainly through the superior haemorrhoidal and inferior mesenteric venous and lymphatic drainage systems 2.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…In particular, extraperitoneal rectal tumours disseminate mainly through the systemic pelvic venous and lateral lymphatic drainage systems, whereas intraperitoneal rectal tumours disseminate mainly through the superior haemorrhoidal and inferior mesenteric venous and lymphatic drainage systems 2. Furthermore, Benzoni et al concluded that tumour location in relation to the peritoneal reflection is a prognostic factor in rectal cancer 2. In this study, it was found that extraperitoneal rectal tumours are more aggressive than intraperitoneal tumours, even when treated by neoadjuvant chemoradiotherapy before surgery, which is common approach in the treatment of rectal cancer 2–4.…”

Section: Introductionmentioning

confidence: 99%

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Is rectal MRI beneficial for determining the location of rectal cancer with respect to the peritoneal reflection?

Jung¹,

Ryu²,

Kim³

et al. 2012

Radiology and Oncology

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BackgroundAn objective method for determining the location of the cancer with respect to peritoneal reflection would be helpful to decide the treatment modality for rectal cancer. This study was designed to evaluate the accuracy and usefulness of rectal MRI to determine spatial relations between the peritoneal reflection and rectal cancer and to compare these with operative findings.Patients and methodsPatients that underwent a rectal cancer operation after a rectal MRI check between November 2008 and June 2010 were considered for the study. The patients that received preoperative concurrent chemoradiation or trans-anal local excision were excluded.ResultsFifty-four patients constituted the study cohort. By comparing surgical and radiologic findings, the accuracy for predicting tumour location in relation to the peritoneal reflection by rectal MRI in all patients was 90.7%. In terms of tumour location in relation to peritoneal reflection, the accuracy of rectal MRI was 93.5% in patients with a tumour located above the peritoneal reflection, 90.0% in patients with a tumour located on the peritoneal reflection, and 84.6% in patients with a tumour located below the peritoneal reflection (p=0.061). When the cohort was subdivided by gender, body mass index (BMI), operative findings, or tumour size, no significant difference was observed among subgroups.ConclusionsRectal MRI could be a useful tool for evaluating the relation between rectal cancer and peritoneal reflection especially when tumour size is less than 8cm. Rectal MRI can provide information regarding the location of rectal cancer in relation to the peritoneal reflection for treatment planning purposes.

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“…28 The DFS and OS were poor for extraperitoneal than for intraperitoneal rectal cancer. Data from Genovesi et all confirmed these evaluations in the multivariate analysis, with a negative influence of extraperitoneal tumor location on DFS and CSS.…”

Section: -14mentioning

confidence: 96%

Retrospective Long-term Results and Prognostic Factors of Treatment for Colorectal Cancer

Baltalarli¹

2013

UHOD

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To evaluate retrospectively 5-10 year overall survival rate in patients with colorectal cancer treated with or without adjuvant therapy for early stage and analyze the impact of some prognostic factors on clinical outcome we retrospectively reviewed 56 patients treated with only surgery, postoperative or preoperative 5-fluorouracil-based chemotherapy and radiotherapy. The following prognostic factors were considered at univariate analyses: age, sex, tumor location, pathological, tumoural and nodal stage, surgical procedure, pathological specimen margins and adjuvant treatment if applied. The 5 and 10 year actuarial rates for overall survival (OS) were 66 % and relapse free survival (RFS) rates were 83% and 58% respectively for all patients. Five years survival was 100%, 73% and 44% respectively for stages I, II and III (p< 0.01). Five years survival for N0, NI and NII disease were 81.3%, 75% and 0% respectively (p< 0.01). Better prognosis was observed for colon cancer compared to rectal and rectosigmoid tumors: 5 years survival rates 90%, 70% and 40% respectively (p< 0.01). Univariate analysis showed that nodal disease, location of tumor in a subsite of colon, pathological stage and surgical procedure had an impact on survival. Our retrospective study showed a good 5-10 year overall survival. Factors as individual pN2, tumor location and advanced pathological stage negatively influenced survival rates. In our opinion to achive better results especially in N2 cancer and rectal and rectosigmoid tumors, especially use of appropriate chemoradiation protocols and new high art radiation technology must be considered in clinical studies in advance. Keywords: Colorectal cancer, Prognostic factors, Radiotherapy ÖZET Kolorektal Kanser Tedavisinin Retrospektif Uzun Dönem Sonuçlar› ve Prognostik FaktörleriKolorektal kanserli ve postoperatif olarak adjuvan veya neoadjuvan tedavi uygulanm›fl veya erken klinik evrede olmas› nedeniyle cerrahi operasyon d›fl›nda ek tedavi uygulanmam›fl olan olgularda 5 ve 10 y›ll›k sa¤kal›m verilerini incelemek ve olas› prognostik faktör-leri belirlemek amac›yla çal›flma retrospektif analiz yöntemiyle planlanm›flt›r. Bu çal›flmada Pamukkale Üniversitesi T›p Fakültesi Radyasyon Onkolojisi Bölümüne tedavi ve izlem için baflvuran ve periyodik kontrollere ça¤›r›lan 56 lokal yerleflimli kolorektal kanserli olgu dosya verileri incelenerek retrospektif yöntemle de¤erlendirilmifltir. Yafl, cinsiyet, tümör evresi, nodal evre, patolojik evre özel-likleri, tümör yerleflimi, cerrahi yöntem, s›n›r tutulumu ve radyoterapi veya kemoterapi adjuvan uygulamalar› gibi de¤iflkenler yönün-den sa¤kal›mlar karfl›laflt›r›lm›fl ve aradaki farklar istatistiksel yönden de¤erlendirilmifltir. Befl ve 10 y›ll›k genel sa¤kal›m oranlar› %66, yinelemesiz sa¤kal›m oranlar› ise s›ras›yla 83% ve 58%dir. Evre I, II ve III için s›ras›yla sa¤kal›m %100, %73 ve %44 olup, N0, N1 ve N2 için s›ras›yla %81.3, %75 ve %0'd›r. Kolon kanseri di¤er rektal ve rektosigmoid yerleflimli tümörlere göre daha iyi sa¤kal›m gös-termekte olup s›...

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Analysis of clinical outcomes and prognostic factors of neoadjuvant chemoradiotherapy combined with surgery: intraperitoneal versus extraperitoneal rectal cancer

Cited by 27 publications

References 19 publications

Risk factors of circumferential resection margin involvement in the patients with extraperitoneal rectal cancer

Risk factors of circumferential resection margin involvement in the patients with extraperitoneal rectal cancer

Is rectal MRI beneficial for determining the location of rectal cancer with respect to the peritoneal reflection?

Retrospective Long-term Results and Prognostic Factors of Treatment for Colorectal Cancer

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