Neoadjuvant radiotherapy improves overall survival for T3/4N+M0 rectal cancer patients: a population-based study of 20300 patients

Abstract

Background: Neoadjuvant radiotherapy (RT) has been shown to improve local control; however, whether it can improve overall survival (OS) in locally advanced rectal cancer (LARC) patients remains controversial. We therefore aimed to examine the benefits of surgery alone, neoadjuvant radiotherapy (RT), adjuvant RT, and surgery plus chemotherapy in stage II (T3/4N0M0) and III (any T and N + M0) on the OS of rectal cancer patients. Methods: Date from the Surveillance, Epidemiology, and End Results (SEER) database diagnosed between 2004 and 2016 were used. Kaplan-Meier analyses were used to compare patient prognoses across different treatment modalities. Cox hazard regression analysis were used to identify independent predictors of OS. Results: For stage T3/4N0M0 patients, neoadjuvant RT, adjuvant RT, and surgery plus chemotherapy resulted in similar OS (all p > 0.05; mean survival, 115.89 months (M), 111.97 M, and 117.22 M, respectively), with better OS observed in these patients than in patients who underwent surgery alone (all p < 0.001, mean survival, 88.96 M). For stage T1/2N + M0 patients, neoadjuvant RT, adjuvant RT, and surgery plus chemotherapy resulted in similar OS (all p > 0.05; mean survival, 121.50 M, 124.25 M, and 121.20 M, respectively), with better OS observed in these patients than in patients who underwent surgery alone (all p < 0.001, mean survival 83.81 M). For stage T3/4N + M0 patients, neoadjuvant RT (HR = 0.436; 95% CI, 0.396~0.478; p < 0.001) resulted in significantly longer OS than adjuvant RT and surgery plus chemotherapy (mean survival, 104.47 M, 93.94 M, and 93.62 M, respectively), with better OS observed in these patients than in patients who underwent surgery alone (all p < 0.001, mean survival 54.87 M). Older age (> 60 years), black race, unmarried status, high tumour grade, and tumour size > 5 cm were all associated with a poor prognosis (all p < 0.05). Conclusions: Neoadjuvant RT, adjuvant RT, and surgery plus chemotherapy results in better OS than surgery alone in LARC patients. Neoadjuvant RT has the potential to be highly recommended over adjuvant RT and surgery plus chemotherapy for T3/4N + M0 patients; however, it showed no OS advantage over adjuvant RT or surgery plus chemotherapy for T3/4N0M0 and T1/2N + M0 patients.

Five Year Survival Outcomes of Prospectively Recorded Cohort Data for Older Adults versus Younger Adults with Resected Primary Rectal Cancer

“…The utilisation of neoadjuvant radiotherapy (7.8%) and neoadjuvant chemotherapy (5.9%) in older adults in our study was low, however, similar to other studies [17] [19]. The role of neoadjuvant radiotherapy and CRT in rectal can- [27]. Other reasons for the low utilisation rates include patient preferences for no neoadjuvant and/or adjuvant therapy, and patient and clinician concerns about excess toxicity such as faecal incontinence and sexual dysfunction, which are more pronounced in older patients [28] [29] [30].…”

Pathological Complete Response Following Different Neoadjuvant Treatment Strategies for Locally Advanced Rectal Cancer: A Systematic Review and Meta-analysis

“… 3 , 4 This combined modality approach decreases recurrence rates and improves survival compared with surgery only. 4 , 5 The most frequently used neoadjuvant treatment strategy for LARC is a combination of radiotherapy (25 × 2 Gy or 28 × 1.8 Gy) and fluoropyrimidine-based chemotherapy [e.g., capecitabine or 5-fluorouracil (5FU)]. Hereby 15–20% of LARC patients achieve a pathological complete response (pCR) in which no tumor is found in the surgical resection specimen.…”

Management of colorectal cancer in the era of COVID-19: Challenges and suggestions

“…14 A 2020 Chinese-based study showed that the majority of patients (53.6%) infected by SARS-CoV-2 were aged 50 or older, which coincides with the predilection age of colorectal cancer, that is, colorectal cancer patients might be at higher risk of acquiring COVID-19 given their average age. 16,17 While hospitals worldwide attempt to isolate COVID-19 patients to specialized hospital wards, many cases are under-recognized or received delayed diagnoses exposing patients in the general medicine ward. 18 CRC is the third most common tumor in men and the second in women.…”