Impact of Interval between Neoadjuvant Chemoradiotherapy and TME for Locally Advanced Rectal Cancer on Pathologic Response and Oncologic Outcome

Wolthuis, Albert; Penninckx, Freddy; Haustermans, Karin; Hertogh, Gert De; Fieuws, Steffen; Cutsem, Éric Van; D’Hoore, André

doi:10.1245/s10434-012-2327-1

Cited by 132 publications

(100 citation statements)

References 29 publications

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“…Some studies have reported increased rates of tumour down-staging when a longer interval between CRT and surgery is employed [21][22][23]. Other studies do not, however, support these findings [2], and a data from definitive large RCTs are therefore awaited with interest [23][24][25].…”

Section: Discussionmentioning

confidence: 99%

Surgical timing after chemoradiotherapy for rectal cancer, analysis of technique (STARRCAT): results of a feasibility multi-centre randomized controlled trial

et al. 2016

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Section: Discussionmentioning

confidence: 99%

Surgical timing after chemoradiotherapy for rectal cancer, analysis of technique (STARRCAT): results of a feasibility multi-centre randomized controlled trial

et al. 2016

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“…This interval in the majority of older studies was between 6 to 7 weeks, while in our study, about 64% underwent surgery 8 weeks or later after the completion of radiotherapy (RT). There are numerous studies indicating that increasing interval between the completion of RT and surgery leads to an increase in pCR in rectal cancer (18). The mean number of resected lymph nodes in our study was 5.2, while this number is usually more than 6…”

Section: Discussionmentioning

confidence: 44%

Outcomes of Neoadjuvant Radiochemotherapy of Locally Advanced Rectal Adenocarcinoma: Results of 8 Year Experience in Iran Cancer Institute

et al. 2017

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Background: Colorectal carcinoma is one of most common cancers in Iran with increasing incidence. The mean age of the affected is decreasing. With progresses in multimodality treatment, we witnessed improved prognosis in colorectal cancers. Objectives: This study aimed at evaluating the outcomes of patients with rectal adenocarcinoma treated with neoadjuvant chemoradiotherapy followed by surgery. Methods: In this retrospective cohort study, we assessed the oncologic treatment outcomes of patients with locally advanced (T3-4 or N+ve) rectal adenocarcinoma in our high volume cancer center, Iran cancer institute, Tehran, Iran. Patients with synchronous metastasis, previous malignancy, and history of pelvic radiation were excluded. The primary endpoint was overall survival (OS) rate and secondary endpoints were disease-free survival and pathologic response. Results: Of patients being treated between 2008 and 2014, 158 were entered to final analysis; they completed planned neoadjuvant treatment and retuned after surgery with pathology report. The mean age was 56 years and mean interval from radiotherapy to surgery was 9 weeks. Thirty percent achieved pathologic complete response. Two-year overall and disease-free survival rate was 87% and 80%, respectively. In multivariate analysis age, sex, local recurrence, clinical stage, and radiotherapy to surgery interval failed to predict OS. The pathologic response (complete vs. non-complete) and the absence of distant metastasis were independent predictors of OS. Conclusions: The rate of pathologic response and survival in our series was comparable to other big randomized studies in the world and even better than previous national reports. These findings emphasize the necessity of treating patients with locally advanced rectal cancer in high volume centers.

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“…In one study evaluating the timing of rectal resection after neoadjuvant chemoradiation therapy, there was no difference in leak rate between patients who had earlier vs later surgery following therapy (,7 vs .7 weeks). 56 In a similar study on esophagectomy patients, there was also no difference in earlier vs later surgery following chemoradiation therapy either (,8 vs .8 weeks). 57 From these studies, we may be able to conclude that longer wait times are unlikely to reduce the risk of anastomotic leakage.…”

Section: Steroids/immune Modulatorsmentioning

confidence: 88%

Reducing gastrointestinal anastomotic leak rates: review of challenges and solutions

Phillips¹

2016

OAS

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Various techniques and interventions have been developed in an effort to obviate gastrointestinal anastomotic leaks. This review is intended to delineate potential modifications that can be made to reduce the risk of anastomotic leaks following gastrointestinal surgery. It may also serve to aid in identifying patients who are at increased risk of anastomotic leak. Modifiable risk factors for leak discussed include malnutrition, smoking, steroid use, bowel preparation, chemotherapy, duration of surgery, use of pressors, intravenous fluid administration, blood transfusion, and surgical anastomotic technique. Based upon literature review, operative techniques should include minimizing operative time, reducing ischemia, and utilizing stapled anastomoses. Buttressing of anastomoses with omentum has proven utility for esophageal surgery. Further recommendations include 5-7 days of immune-modifying nutritional supplementation for malnourished patients, discontinuation of smoking in the perioperative period, limiting steroid use, utilization of oral antibiotic preparation for colorectal surgery, avoidance of early operations (,4 weeks) following chemotherapy, limiting pressor use, and the utilization of goal-directed fluid management.

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Impact of Interval between Neoadjuvant Chemoradiotherapy and TME for Locally Advanced Rectal Cancer on Pathologic Response and Oncologic Outcome

Abstract: In this retrospective analysis, there seems to be an association between a longer interval after neoadjuvant chemoradiotherapy and complete pathologic response without affecting postoperative morbidity and length of hospital stay, and with no detrimental effect on oncologic outcome.

Cited by 132 publications

References 29 publications

Surgical timing after chemoradiotherapy for rectal cancer, analysis of technique (STARRCAT): results of a feasibility multi-centre randomized controlled trial

Surgical timing after chemoradiotherapy for rectal cancer, analysis of technique (STARRCAT): results of a feasibility multi-centre randomized controlled trial

Outcomes of Neoadjuvant Radiochemotherapy of Locally Advanced Rectal Adenocarcinoma: Results of 8 Year Experience in Iran Cancer Institute

Reducing gastrointestinal anastomotic leak rates: review of challenges and solutions

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