In the era of total mesorectal excision: adjuvant radiotherapy may be unnecessary for pT3N0 rectal cancer

Wang, Junxin; Wang, Yu; Chen, Na; Chen, Luchuan; Bai, Péter; Pan, Jianji

doi:10.1186/1748-717x-9-159

Cited by 10 publications

(12 citation statements)

References 30 publications

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“…Results showed that local recurrence rate did not differ between patients who did and did not receive radiotherapy [7]. Furthermore, in patients with mid and lower rectal cancer, the local recurrence rate was not affected by radiotherapy [7, 14], which was contradicted to our findings. Possible explanation was that we chose the cut-off of 7 cm from AV to separate the patients into lower and upper cancer groups while Park et al used the cut-off of 5 and 10 cm to divide the patients into three groups.…”

Section: Discussioncontrasting

confidence: 91%

Tumor location as an indication for adjuvant radiotherapy in pT3N0 rectal cancer after surgery

Peng

Zhou

et al. 2019

Radiat Oncol

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BackgroundThe optimal care for pT3N0 rectal cancer remains controversial. And whether tumor location can be used to guide the administration of adjuvant radiotherapy for pT3N0 rectal cancer is not fully confirmed. The current study was designed to identify the benefit of adjuvant radiotherapy for pT3N0 rectal cancer.MethodsWe performed a retrospective study of 265 pT3N0 rectal cancer patients who were treated by surgery and adjuvant therapy from Mar. 2005 to Sept. 2015. All patients were divided into two groups according to receiving adjuvant radiotherapy or not. Overall survival (OS), disease-free survival (DFS) were compare between patients who did and did not receive adjuvant radiotherapy. Multivariate analysis was performed to explore clinical factors significantly associated with DFS, local recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS).ResultsFor patients with lower tumor, DFS in adjuvant chemo-radiotherapy group was higher than that in adjuvant chemotherapy group. Besides, the rates of local recurrence and distant metastasis were found lower in patients who did receive adjuvant radiotherapy than those who did not. For patients with upper tumor, the 5-year OS and DFS were similar between groups of adjuvant chemotherapy and adjuvant chemo-radiotherapy. Multivariable analysis indicated both the CEA and tumor location were independent predictors of LRFS. And adjuvant radiotherapy predicted the DFS, LRFS and DMFS in lower rectal cancer patients.ConclusionTumor location can serve as an indication for the administration of adjuvant radiotherapy in pT3N0 rectal cancer patients.

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Section: Discussioncontrasting

confidence: 91%

Tumor location as an indication for adjuvant radiotherapy in pT3N0 rectal cancer after surgery

Peng

Zhou

et al. 2019

Radiat Oncol

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“…In the era of TME, pT3N0 rectal cancer which had the most favorable outcome within the group of locally advanced rectal cancer also showed much-improved outcomes. Several retrospective studies reported LRR rates of 4%–19% in patients with pT3N0 disease treated with TME and not irradiated, which was quite lower than in the pre-TME era [8,9,12-14]. Although RT improves local control, RT-related toxicity, such as gastrointestinal toxicity, genitourinary toxicity, and sexual dysfunction, could occur [5].…”

Section: Discussionmentioning

confidence: 99%

“…Currently, neoadjuvant chemoradiotherapy (CCRT) followed by TME in locally advanced rectal cancer is considered as standard management. In this era, it is much controversial that adjuvant RT is necessary, when clinically T2 or early T3N0 rectal cancer is treated via upfront surgery with TME and the pathologic stage is T3N0M0 with sufficient circumferential resection margin (CRM) [7,9-12]. In those cases, adjuvant RT only for patients with high-risk features should be considered to reduce unnecessary exposure to RT and/or RT-related toxicities.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for locoregional recurrence in patients with pathologic T3N0 rectal cancer with negative resection margin treated by surgery alone

Baek

Park

et al. 2019

Radiat Oncol J

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Purpose This study aimed to identify prognostic factors for locoregional recurrence (LRR) in pT3N0 rectal cancer patients who were treated with surgery alone and had negative resection margin including circumferential resection margin (CRM) for optimal indication of adjuvant radiotherapy. Materials and Methods We reviewed patients with pT3N0 rectal cancer who were treated via upfront surgery and had no other adjuvant treatment from January 2003 to December 2012. In total, 122 patients who had negative resection margin including negative CRM were included in the analysis. Results The median follow-up period after surgery was 60 months (range, 3 to 161 months). During this time, 6 patients (4.9%) experienced LRR at the anastomotic site (4 patients), and regional lymphatic area (2 patients). The estimated 5-year rates of overall survival, recurrence-free survival, and LRR-free survival were 96.7%, 84.6%, and 94.0%, respectively. Multivariate analysis showed that level of tumor ≤5 cm was a significant prognostic factor for LRR-free survival (LRRFS) (p = 0.04; hazard ratio = 7.08; 95% confidence interval, 1.06–47.30). Patients with level of tumor ≤5 cm had an estimated 5-year LRRFS of 66.8%, which was much higher than 2.3% in patients with level of tumor >5 cm. There was no significant factor for recurrence-free survival or overall survival. Conclusion In T3N0 rectal cancer, adjuvant chemoradiotherapy should be recommended in patients with level of tumor ≤5 cm for better local control. However, in patients with pT3N0 disease, negative resection margin, and level of tumor >5 cm, adjuvant chemoradiotherapy should be carefully suggested.

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“…However, some studies have found no improvement in the local control rate after adjuvant radiotherapy for stage II cancer patients . Another retrospective analysis from our institution has also cast doubt on the benefit of adjuvant radiotherapy for the entire cohort of pT3N0 patients, especially in the era of total mesorectal excision . Our novel risk‐stratification model successfully identified a subgroup of high‐risk pT3N0 patients who might benefit from adjuvant radiotherapy.…”

Section: Discussionmentioning

confidence: 89%

Role of postoperative radiotherapy in pT3N0 rectal cancer: A risk‐stratification system based on population analyses

Huang

Lin

et al. 2019

Cancer Medicine

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The impact of adjuvant radiotherapy in pT3N0 rectal cancer is controversial. We aimed to determine the risk factors for cancer‐specific survival (CSS) among these patients and to develop a risk‐stratification system to identify which of these patients would benefit from adjuvant radiotherapy. In this review of the Surveillance, Epidemiology, and End Results database (2010‐2014), we analyzed the data of pT3N0 rectal cancer patients who had not undergone neoadjuvant radiotherapy. Prognostic factors were identified using the Cox proportional hazards model, and risk scores were derived according to the β regression coefficient. A total of 1021 patients were identified from the database search. The overall 5‐year CSS was 86.31%. Multivariate analysis showed that age (P < 0.001), tumor differentiation (P = 0.044), number of nodes resected (P = 0.032), marital status (P = 0.005), and radiotherapy (P = 0.006) were independent prognostic factors for CSS. A risk‐stratification system composed of age, tumor differentiation, and number of nodes resected was generated. Low‐risk patients had better CSS than high‐risk patients (92.13% vs 72.55%, P < 0.001). The addition of radiotherapy to surgery doubled the CSS among the high‐risk patients (42.06% vs 91.26%, P = 0.001) but produced no survival benefit among the low‐risk patients (93.36% vs 96.38%, P = 0.182). Our risk‐stratification model based on age, tumor differentiation, and number of nodes resected predicted the outcomes of pT3N0 rectal cancer patients. This model could help identify patients who may benefit from adjuvant radiotherapy.

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In the era of total mesorectal excision: adjuvant radiotherapy may be unnecessary for pT3N0 rectal cancer

Cited by 10 publications

References 30 publications

Tumor location as an indication for adjuvant radiotherapy in pT3N0 rectal cancer after surgery

Tumor location as an indication for adjuvant radiotherapy in pT3N0 rectal cancer after surgery

Risk factors for locoregional recurrence in patients with pathologic T3N0 rectal cancer with negative resection margin treated by surgery alone

Role of postoperative radiotherapy in pT3N0 rectal cancer: A risk‐stratification system based on population analyses

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