Preoperative or Postoperative Therapy for Stage II or III Rectal Cancer: An Updated Practice Guideline

Wong, Rebecca; Berry, Scott; Spithoff, Karen; Šimunović, Marko; Chan, Kelvin; Agboola, O.; Dingle, Brian

doi:10.1016/j.clon.2010.03.002

Cited by 49 publications

(35 citation statements)

References 21 publications

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“…this represents an important opportunity to improve the quality of care in the province by moving toward routine use of neoadjuvant radiation or chemoradiation. 6,[20][21][22] We did note a trend toward increased use of neoadjuvant radiotherapy between 2004 and 2006 and a corresponding trend toward lower local recurrence rates. this trend may stem from the influence of the 2004 study by sauer et al 22 that analyzed the role of preoperative versus postoperative chemoradiotherapy for rectal cancer.…”

Section: Discussionmentioning

confidence: 98%

Geographical Disparities of Rectal Cancer Local Recurrence and Outcomes

Helewa

Turner

Wirtzfeld

et al. 2013

Diseases of the Colon &Amp; Rectum

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Local recurrence rates for rectal cancer are high in Manitoba. Geography is an important variable, because rural status is associated with higher local recurrence rates and decreased survival. The use of neoadjuvant radiotherapy was an important predictor of lower local recurrence rates. Further initiatives are imperative to identify why rural patients experience differences in outcomes in Manitoba.

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Section: Discussionmentioning

confidence: 98%

Geographical Disparities of Rectal Cancer Local Recurrence and Outcomes

Helewa

Turner

Wirtzfeld

et al. 2013

Diseases of the Colon &Amp; Rectum

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“…8 Canadian guidelines recommend administration of neo-CRT by excluding medically unfit patients who should be treated with preoperative radiotherapy alone. 15 The European Society for Medical Oncology consensus guidelines indicate the equal value of neo-RT and neo-CRT in the treatment of rectal cancer with intermediate risk whereas in the locally advanced nonresectable cases neo-CRT is the recommended option in fit patients and recommend administration of concomitant chemotherapy for all patients if long-term radiation is used. 3,4 Two Cochrane reviews of 6 RCTs in total reported that administration of neo-CRT compared with neo-RT for stage III rectal cancer patients had no effect on overall or disease-free survival but reduced the risk of local recurrence.…”

Section: Discussionmentioning

confidence: 99%

Neoadjuvant Therapy in Rectal Cancer Patients With Clinical Stage II to III Across European Countries: Variations and Outcomes

Babaei

Jansen

Balavarca

et al. 2018

Clinical Colorectal Cancer

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This study is the largest observational study on neoadjuvant therapy in patients with stage II & III rectal cancer by including high-quality data from large population-based and clinical cancer registries. We observed large variations in administration of neoadjuvant chemo(radio)therapy across European countries. Our results support major survival advantages of patients treated with neoadjuvant radiotherapy. Background Neoadjuvant therapy improves survival of patients with clinical stage II and III rectal cancer in clinical trials. In this study, we investigated the administration of neoadjuvant radiotherapy (neo-RT) and neoadjuvant chemoradiotherapy (neo-CRT) and its association with survival in resected patients in 2 European countries (The Netherlands and Sweden) and at 3 specialist centers. Materials and Methods Administration of neoadjuvant treatment (all registries) and overall survival after surgery in The Netherlands and Sweden were assessed. Hazard ratios (HRs) were obtained using Cox regression adjusted for potential confounders. Results A total of 16,095 rectal cancer patients with clinical stage II and III were eligible for analyses. Large variations in administration of neo-RT and neo-CRT were observed. Elderly patients less often received neo-RT and neo-CRT. Patients with stage III disease received neo-CRT more frequently than neo-RT. Administration of neo-RT versus surgery without neoadjuvant treatment was significantly associated with improved survival in The Netherlands (HR, 0.62; 95% confidence interval [CI], 0.53–0.73) as well as in Sweden (HR, 0.79; 95% CI, 0.69–0.90). Administration of neo-CRT was associated with enhanced survival in The Netherlands (HR, 0.62; 95% CI, 0.50–0.78) but not in Sweden (HR, 0.97; 95% CI, 0.80–1.18). The mortality of patients treated with neo-CRT compared with neo-RT showed inconsistent results in population-based centers. Conclusions Our results support an association of neo-RT with enhanced survival among stage II and III rectal cancer patients. Comparing neo-CRT with neo-RT, larger variations and inconsistent results with respect to survival were observed across centers.

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“…Factors strongly associated with not receiving adjuvant chemotherapy were: patient age 75 years or older; diagnosed with stage II disease; presence of one or more serious co-morbidities; living in neighborhoods with low socio-economic indicators; and region of residence. Both clinical trials and population-based studies have shown that elderly patients and those with co-morbidities can benefit from pre-operative [6,9,10] and post-operative [8,[22][23][24][25][26] therapy. Older age and co-morbidities may be related to postsurgical complications or delayed recovery that could affect whether a patient received adjuvant chemotherapy and/or the timing of it; we were not able to evaluate these possibilities in our study.…”

Section: Discussionmentioning

confidence: 99%

Timing of Adjuvant Chemotherapy and Survival in Patients with Stage II/III Rectal Cancer

Lima¹,

Yasui²,

Scarfe³

et al. 2012

JCT

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Background: Treatment guidelines in the 1990s established surgery followed by chemoradiotherapy as the standard treatment for stage II/III rectal cancer. Our aim was to investigate the association between the timing of adjuvant treatment and patient survival in practice and identify demographic/clinical factors associated with treatment patterns. Methods: All residents of Alberta diagnosed with stage II/III rectal adenocarcinoma in 2000-2005 who had surgery were included in the study. Demographic and clinical data were obtained from the Alberta Cancer Registry and linked to hospital data and socioeconomic data from the 2001 Canadian Census. Overall and cancer-specific hazard ratios of death were estimated using Cox proportional hazards models. Results: 1243 patients were included in the study; 636 (51%) patients received treatment consistent with guidelines. Patients who received adjuvant chemotherapy 12 -16 weeks after surgery or more than 16 weeks/ did not receive it had a 43% and 58% higher risk of rectal cancer death, respectively, compared to those who received it within 8 weeks of surgery. Conclusion: Adjuvant chemotherapy for stage II/III rectal cancer should be initiated within 12 weeks after surgery to maximize treatment benefits. Efforts to increase the proportion of patients treated within 12 weeks after surgery are needed.

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Preoperative or Postoperative Therapy for Stage II or III Rectal Cancer: An Updated Practice Guideline

Cited by 49 publications

References 21 publications

Geographical Disparities of Rectal Cancer Local Recurrence and Outcomes

Geographical Disparities of Rectal Cancer Local Recurrence and Outcomes

Neoadjuvant Therapy in Rectal Cancer Patients With Clinical Stage II to III Across European Countries: Variations and Outcomes

Timing of Adjuvant Chemotherapy and Survival in Patients with Stage II/III Rectal Cancer

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