Nationwide improvement of rectal cancer treatment outcomes in Norway, 1993–2010

Guren, Marianne G.; Kørner, Hartwig; Pfeffer, F.; Myklebust, Tor Åge; Eriksen, Morten; Edna, Tom-Harald; Larsen, Stein Gunnar; Knudsen, Kristin Oterholt; Nesbakken, Arild; Wasmuth, Hans H.; Vonen, Barthold; Hofsli, Eva; Færden, Arne E.; Brændengen, Morten; Dahl, Olav; Steigen, Sonja Eriksson; Johansen, Magnar J.; Lindsetmo, Rolv-Ole; Drolsum, Anders; Tollåli, Geir; Dørum, Liv Marit; Møller, Bjørn; Wibe, Arne

doi:10.3109/0284186x.2015.1034876

Cited by 74 publications

(72 citation statements)

References 31 publications

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“…These changes include centralized and improved surgery, multidisciplinary teams [3][4][5], preoperative radiotherapy in rectal cancer [9,10] and more precise adjuvant treatments [6][7][8]. However, also the regional healthcare systems have changed accordingly, and based on a single clinical trial or study registry, it is challenging to analyze the impact of different changes in the treatment results of CRC.…”

Section: Discussionmentioning

confidence: 99%

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Trends in presentation, treatment and survival of 1777 patients with colorectal cancer over a decade: a Biobank study

et al. 2017

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Background: Most survival data in colorectal cancer (CRC) is derived from clinical trials or registerbased studies. Hospital Biobanks, linked with hospital electronic records, could serve as a data-gathering method based on consecutively collected tumor samples. The aim of this Biobank study was to analyze survival of colorectal patients diagnosed and treated in a single-center university hospital over a period of 12 years, and to evaluate factors contributing to outcome.

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Section: Discussionmentioning

confidence: 99%

“…Controlled quality and centralization of surgery, both in rectal [3,4] and colon cancer [5] and the use of adjuvant chemotherapy [6][7][8] have improved the survival of patients with CRC. Additionally, in rectal cancer, preoperative radiotherapy or chemoradiotherapy have significantly improved survival [9,10].…”

Section: Introductionmentioning

confidence: 99%

Trends in presentation, treatment and survival of 1777 patients with colorectal cancer over a decade: a Biobank study

et al. 2017

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“…If locally advanced, preoperative chemoradiotherapy is recommended for tumour downsizing followed by rectal resection 6-8 weeks after completion of radiotherapy [1,2]. Synchronous liver metastases occur in 15%-25% of patients with rectal cancer [3][4][5] and, if resectable, have generally been resected after the surgery for the primary tumour. This approach may allow liver metastases to progress and become unresectable.…”

Section: Introductionmentioning

confidence: 99%

Resection of synchronous liver metastases between radiotherapy and definitive surgery for locally advanced rectal cancer: short‐term surgical outcomes, overall survival and recurrence‐free survival

et al. 2017

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Aim There is debate as to the correct treatment algorithm sequence for patients with locally advanced rectal cancer with liver metastases. The aim of the study was to assess safety, resectability and survival after a modified 'liver-first' approach.Method This was a retrospective study of patients undergoing preoperative radiotherapy for the primary rectal tumour, followed by liver resection and, finally, resection of the primary tumour. Short-term surgical outcome, overall survival and recurrence-free survival are reported.Results Between 2009 and 2013, 45 patients underwent liver resection after preoperative radiotherapy. Thirtyfour patients (76%) received neoadjuvant chemotherapy, 24 (53%) concomitant chemotherapy during radiotherapy and 17 (43%) adjuvant chemotherapy. The median time interval from the last fraction of radiotherapy to liver resection and rectal surgery was 21 (range 7-116) and 60 (range 31-156) days, respectively. Rectal resection was performed in 42 patients but was not performed in one patient with complete response and two with progressive metastatic disease. After rectal surgery three patients did not proceed to a planned second stage liver (n = 2) or lung (n = 1) resection due to progressive disease. Clavien-Dindo ≥Grade III complications developed in 6.7% after liver resection and 19% after rectal resection. The median overall survival and recurrence-free survival in the patients who completed the treatment sequence (n = 40) were 49.7 and 13.0 months, respectively. Twenty of the 30 patients who developed recurrence underwent further treatment with curative intent. ConclusionThe modified liver-first approach is safe and efficient in patients with locally advanced rectal cancer and allows initial control of both the primary tumour and the liver metastases.Keywords Locally advanced rectal cancer, synchronus colorectal liver metastases, liver-first approach What does this paper add to the literature? The optimal management of patients with locally advanced rectal cancer and synchronous liver metastases is controversial. This study is the first to show that liver resection in the time window between radiotherapy and rectal surgery is a safe and efficient alternative to the traditional liver-first approach.

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“…During recent decades, advances in surgical technique, diagnostics, radiotherapy and new oncologic drugs have contributed to improved outcomes in rectal cancer (RC), including prolonged survival in metastatic disease [1]. However, patients with locally recurrent or primarily inoperable RC may still experience a growing pelvic tumor, potentially leading to symptoms, such as pain, obstruction, and hematochezia [2].…”

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confidence: 99%

Palliative pelvic radiotherapy for symptomatic rectal cancer – a prospective multicenter study

et al. 2016

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Background and purpose: Palliative pelvic radiotherapy (PPRT) is used to treat locally advanced rectal cancer (RC) although symptomatic effects and toxicities are poorly documented. Aims were to evaluate symptom severity, quality of life (QOL) and toxicity after PPRT. Material and methods: Fifty-one patients with symptomatic primary or recurrent RC prescribed PPRT with fractions of 3 Gy to 30-39 Gy were included. Primary outcome was severity of target symptoms (TS) 12 weeks after PPRT. Pelvic symptom burden, toxicity, and QOL were assessed. Response was defined as patient-reported TS improvement or resolution. Results: Pain (n ¼ 24), rectal dysfunction (n ¼ 16), and hematochezia (n ¼ 9) were the most common TSs. Overall response rate among evaluable patients 12 weeks after PPRT was 28/33 (85%). Eighteen patients did not complete the study follow-up, 16 due to deteriorating health. TS responses were 10/13 (77%) for pain, 9/10 (90%) for rectal dysfunction, and 8/8 for hematochezia. Non-target pelvic symptom severity decreased and median QOL scores remained stable. There was no grade 4 toxicity. Median survival was nine months. Conclusions: In the majority of patients with symptomatic primary or recurrent RC, PPRT with 30-39 Gy contributes to pelvic symptom relief, with little toxicity. Patients prescribed PPRT of RC have limited life expectancy. Future studies should investigate simplification of PPRT.

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Nationwide improvement of rectal cancer treatment outcomes in Norway, 1993–2010

Abstract: Long-term outcomes from a national population-based rectal cancer registry are presented. Improvements in rectal cancer treatment have led to decreased recurrence rates of 5% and increased survival on a national level.

Cited by 74 publications

References 31 publications

Trends in presentation, treatment and survival of 1777 patients with colorectal cancer over a decade: a Biobank study

Trends in presentation, treatment and survival of 1777 patients with colorectal cancer over a decade: a Biobank study

Resection of synchronous liver metastases between radiotherapy and definitive surgery for locally advanced rectal cancer: short‐term surgical outcomes, overall survival and recurrence‐free survival

Palliative pelvic radiotherapy for symptomatic rectal cancer – a prospective multicenter study

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