Neoadjuvant chemoradiation improves oncologic outcomes in low and mid clinical T3N0 rectal cancers

Lavryk, Olga; Manilich, Elena; Valente, Michael; Miriam, Arshiya; Görgün, Emre; Kalady, Matthew F.; Shawki, Sherief; Delaney, Conor P.; Steele, Scott R.

doi:10.1007/s00384-019-03452-6

Cited by 3 publications

(3 citation statements)

References 31 publications

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“…Furthermore, quality of TME surgery has significantly improved over time, which has diminished the absolute risk reduction that can be obtained by adding neoadjuvant radiotherapy. The overall rate of positive resection margins in the TME trial was 15%, while the current rate of incomplete resection is below 10% overall, and below 5% for early to intermediate risk rectal cancer without neoadjuvant radiotherapy 26‐28 …”

Section: Discussionmentioning

confidence: 99%

“…cancer without neoadjuvant radiotherapy. [26][27][28] Patients Although analyzing overstaging was not the aim of the analysis, Table 2 shows it does occur. Although the numbers are small, due to the neoadjuvant therapies that hamper analyses on overstaging, it is a problem discussed in literature.…”

Section: Multivariable Analysis Revealed That For Patients With (Y)pn1mentioning

confidence: 99%

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Effect of understaging on local recurrence of rectal cancer

Giesen

Borstlap

Bemelman

et al. 2020

Journal of Surgical Oncology

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Background and Objectives: Magnetic resonance imaging of the pelvis has a limited accuracy to detect positive lymph nodes but does dictate neoadjuvant treatment in rectal cancer. This study aimed to investigate preoperative lymph node understaging and its effects on postoperative local recurrence rate. Methods: Patients were selected from a retrospective cross-sectional snapshot study. Patients with emergency surgery, cM1 disease, or unknown cN-or (y)pN category were excluded. Clinical and pathologic N-categories were compared and the impact on local recurrence was determined by multivariable analysis. Results: Out of 1548 included patients, 233 had preoperatively underestimated lymph node staging based on (y)pN category. Out of the 695 patients staged cN0, 168 (24%) had positive lymph nodes at pathology, and out of the 594 patients staged cN1, 65 (11%) were (y)pN2. Overall 3-year local recurrence rate was 5%. Clinical N-category was not associated with local recurrence when corrected for pT-category, neoadjuvant therapy, and resection margin, neither in patients with (y)pN1 (hazard ratio [HR]: 1.67 (95% confidence interval [CI]: 0.68-4.12) P = .263) nor (y)pN2-category (HR: 1.91 95% CI: [0.75-4.84], P = .175). Conclusion: Preoperative understaging of nodal status in rectal cancer is not uncommon. No significant effect on local recurrence or overall survival rates were found in the present study.

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Section: Discussionmentioning

confidence: 99%

Section: Multivariable Analysis Revealed That For Patients With (Y)pn1mentioning

confidence: 99%

Effect of understaging on local recurrence of rectal cancer

Giesen

Borstlap

Bemelman

et al. 2020

Journal of Surgical Oncology

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“…For middle and lower stage II and III rectal cancer, preoperative radiotherapy or CRT can reduce the local recurrence rate without improving OS ( 23 ). Lavryk et al showed that the distance between the tumor and anal verge was an independent prognostic parameter ( 24 ). Therefore, these factors could be considered when assessing the need for neoadjuvant therapy in stage IIA patients.…”

Section: Discussionmentioning

confidence: 99%

Survival comparison of stage IIA rectal cancer with or without neoadjuvant therapy: a SEER database analysis with propensity score matching

Han¹,

Wang²,

Wu³

et al. 2022

J Gastrointest Oncol

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Background: Patients with stage IIA rectal cancer have a higher survival rate but side effects from chemoradiotherapy; thus, whether neoadjuvant therapy should be performed for stage IIA rectal cancer is controversial. This study aimed to compare the survival outcomes of patients with stage IIA rectal cancer with or without neoadjuvant chemoradiotherapy.Methods: Patients with stage IIA rectal cancer between 2010 and 2015 were included through the Surveillance, Epidemiology, and End Results database. Propensity score matching was used to reduce the impact of confounding factors. Survival curves were plotted using the Kaplan-Meier method, and survival differences were assessed using the log-rank test.Results: There were no significant differences in overall survival and cancer-specific survival between the neoadjuvant chemoradiotherapy and surgery groups (P=0.973 and 0.983). Compared with the surgery group, the neoadjuvant chemoradiotherapy + surgery + chemotherapy group had a better overall survival (P=0.007).Subgroup analysis showed that the neoadjuvant chemoradiotherapy + surgery + chemotherapy group had better overall survival compared to the surgery group in the subgroup containing preoperative high-risk factors (P=0.003) but not in the low-risk subgroup (P=0.685).Conclusions: There is no evidence that neoadjuvant chemoradiotherapy + surgery can improve overall survival and cancer-specific survival compared to surgery alone in patients with stage IIA rectal cancer.Neoadjuvant chemoradiotherapy + surgery + chemotherapy can improve overall survival compared to surgery alone, but only in patients with preoperative high-risk factors. We suggest that patients with no preoperative high-risk factors may be considered for surgery alone, neoadjuvant chemoradiotherapy + surgery + chemotherapy is recommended for patients with preoperative risk factors.

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