Is Chemoradiotherapy Beneficial for Stage IV Rectal Cancer?

Huh, Jung Wook; Kim, Hee Cheol; Park, Hee Chul; Choi, Doo Ho; Park, Joon Oh; Park, Young Suk; Park, Yoon Ah; Cho, Yong Beom; Yun, Seong Hyeon; Lee, Woo Yong; Chun, Ho Kyung

doi:10.1159/000371390

Cited by 10 publications

(8 citation statements)

References 12 publications

(23 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Indeed, stage IV rectal cancers comprise a heterogeneous group, which impedes the progress of prospective studies. Several studies with small sample size compared of local recurrence rate and overall survival of stage IV rectal cancer patients with or without neoadjuvant chemoradiotherapy and the results are inconsistent 11-14. In the present study, we demonstrated that patients with resectable rectal cancer received radiotherapy before definitive primary resection surgery had better prognosis than radiotherapy after surgery using a relative large-population bases database.…”

Section: Discussionmentioning

confidence: 50%

See 1 more Smart Citation

Survival Benefit of Preoperative Versus Postoperative Radiotherapy in Metastatic Rectal Cancer Treated With Definitive Surgical Resection of Primary Tumor: A Population Based, Propensity Score-Matched Study

Luo¹,

Liu²,

Zhu³

et al. 2019

J. Cancer

View full text Add to dashboard Cite

Preoperative chemoradiation followed by surgery has been recommended as a standard treatment for patients with stage II/III rectal cancer. However, the optimal sequencing of radiotherapy for metastatic rectal cancer remains unclear. Between 2004 and 2014, patients diagnosed with metastatic rectal cancer who underwent the resection of primary site and received radiotherapy were retrospectively selected using the Surveillance, Epidemiology, and End Results (SEER) database. The propensity score matching analyses were used to lessen the effects of confounding factors including age, sex, race, marital status, serum carcinoembryonic antigen level, histologic type, differentiation status, tumor size, T stage, N stage and resection of the distant lesions. The cancer-specific survival (CSS) were compared based on the sequencing of radiotherapy. Ultimately, 686 matched pairs were formed for comparison of preoperative versus postoperative radiotherapy. The 5-year CSS estimates were 33.4% (95% CI: 28.9%-37.9%) and 26.8% (95% CI: 22.7%-30.9%) for patients underwent preoperative radiotherapy followed by resection of primary lesion and postoperative radiotherapy after surgery, respectively. Patients underwent preoperative radiotherapy had better CSS as compared to patients received postoperative radiotherapy (p<0.001 for log-rank test). Multivariate analysis demonstrated that preoperative radiotherapy group was associated with significantly decreased risk for cancer death (HR=0.820, 95% CI: 0.712-0.945, p=0.006). Preoperative radiotherapy was superior to postoperative radiotherapy in patients with metastatic rectal cancer. Therapeutic strategy for these patients should be further explored.

show abstract

Section: Discussionmentioning

confidence: 50%

“…Huh et al 11 reported the outcomes of 69 patients received chemoradiotherapy and 71 patients did not. They found that preoperative radiotherapy improved local control of metastatic rectal cancer while postoperative radiotherapy did not.…”

Section: Discussionmentioning

confidence: 99%

Survival Benefit of Preoperative Versus Postoperative Radiotherapy in Metastatic Rectal Cancer Treated With Definitive Surgical Resection of Primary Tumor: A Population Based, Propensity Score-Matched Study

Luo¹,

Liu²,

Zhu³

et al. 2019

J. Cancer

View full text Add to dashboard Cite

show abstract

“…Meanwhile, we find several reports demonstrated chemoradiotherapy prefer to have higher benefits in improving local control rather than OS. A recent study found that rectal cancer patients received radiotherapy had an improved local control, however, that was not significantly in improving OS (27). Additionally, patients with postoperative radiotherapy were observed to have reduced local recurrence rate in rectal cancer (28,29).…”

Section: Discussionmentioning

confidence: 97%

The efficacy of postoperative radiotherapy for locally advanced rectal cancer without neoadjuvant therapy

Yu¹,

Wang²,

Song³

et al. 2018

Transl. Cancer Res

View full text Add to dashboard Cite

Background: The 2018 guidelines for treatment of cancer by site recommended by the National Comprehensive Cancer Network (NCCN) does not include a specific treatment recommendation for rectal cancer patients who did not receive preoperative chemoradiotherapy. The study objective was to evaluate whether postoperative radiotherapy was effective for such patients.Methods: Survival was evaluated in 9,585 patients who underwent surgical resection for stage II or III rectal cancer and were registered in the Surveillance, Epidemiology, and End Results-Medicare database between 1992 and 2009. Overall survival (OS) benefit in propensity score (PS)-matched patient cohorts were estimated by Cox proportional hazards models.Results: After stratification by chemotherapy regimen, the difference in OS of stage III patients between the no-treatment and radiotherapy groups was significant (P<0.001). However, there was no significant difference in OS of stage III patients between 5-fluorouracil (5-FU) and 5-FU/radiotherapy groups (P=0.267).Also, the difference in OS between the FOLFOX and FOLFOX/radiotherapy groups was not significant (P=0.649). The PS-matching analysis confirmed aforementioned results. Conclusions:The evidence obtained in this study does not support postoperative radiotherapy for stage II rectal cancer or stage III patients who received postoperative chemotherapy. The use of postoperative radiotherapy for stage III patients who did not receive postoperative chemotherapy could increase OS.

show abstract

“…Most series include patients who had non-surgical management of synchronous metastasis and differences in timing of radiotherapy (10,(15)(16)(17)(18)(19)(20). The most relevant comparisons to our work involve two studies, which investigated the value of RT in patients undergoing curative surgery.…”

Section: Discussionmentioning

confidence: 99%

The role of neoadjuvant radiotherapy for locally-advanced rectal cancer with resectable synchronous metastasis

Fossum¹,

Alabbad²,

Romak³

et al. 2017

J. Gastrointest. Oncol.

View full text Add to dashboard Cite

Background: Although neoadjuvant radiotherapy is typically administered for locally-advanced rectal cancer to reduce local recurrence (LR), its role for patients who present with synchronous resectable liver and/or lung metastasis is not well defined. The aim of this study was to evaluate the role of neoadjuvant radiotherapy for patients with stage IV rectal cancer undergoing curative-intent surgery. Methods: This study is a retrospective review of a prospectively maintained surgical registry of all consecutive adult patients who underwent curative-intent resection at Mayo Clinic in Rochester, MN, from January 1990 until December 2014 with a median follow-up time of 43 (IQR 16-67) months. Eligible patients had locally-advanced rectal cancer (T3, T4 and/or nodal involvement) with synchronous resectable liver and/or lung metastasis. Exclusion criteria were as follows: patients with primary tumor stage of T1N0 or T2N0, patients with metastasis to organs other than the liver or lung, patients who had palliative resection, patients who had non-surgical treatment of synchronous metastasis (e.g., radiofrequency ablation), patients who received postoperative radiotherapy, or absence of research authorization. Ninety three patients were included of which 47 received neoadjuvant radiotherapy and 46 did not. All patients received neoadjuvant chemotherapy +/− radiotherapy followed by curative-intent surgery with metastasectomy performed either simultaneously with resection of the primary tumor or as a planned staged resection. The primary outcomes of this study are LR, distant metastasis, overall and disease-specific survival (DSS).Results: LR was observed in 12 patients (26%) who did not receive radiotherapy, while no LR developed in those who received neoadjuvant radiotherapy, P<0.001. Univariate analysis showed that neither age, sex, ASA class, BMI, tumor location, procedure performed, or neoadjuvant chemotherapy were associated with subsequent LR. The 5-year overall survival (OS) rates were: 43.3% (95% CI: 30.1, 62.3) for no radiotherapy vs. 58.3% (95% CI: 43.4, 78.2) with radiotherapy.Conclusions: Neoadjuvant radiotherapy should be considered in patients with locally-advanced stage IV rectal cancer. These data add to the evidence supporting neoadjuvant radiotherapy in the setting of resectable metastatic disease.

show abstract

Is Chemoradiotherapy Beneficial for Stage IV Rectal Cancer?

Cited by 10 publications

References 12 publications

Survival Benefit of Preoperative Versus Postoperative Radiotherapy in Metastatic Rectal Cancer Treated With Definitive Surgical Resection of Primary Tumor: A Population Based, Propensity Score-Matched Study

Survival Benefit of Preoperative Versus Postoperative Radiotherapy in Metastatic Rectal Cancer Treated With Definitive Surgical Resection of Primary Tumor: A Population Based, Propensity Score-Matched Study

The efficacy of postoperative radiotherapy for locally advanced rectal cancer without neoadjuvant therapy

The role of neoadjuvant radiotherapy for locally-advanced rectal cancer with resectable synchronous metastasis

Contact Info

Product

Resources

About