Preoperative radiotherapy and local excision of rectal cancer: Long-term results of a randomised study

Wawok, Przemysław; Polkowski, Wojciech; Richter, Piotr; Szczepkowski, Marek; Olędzki, Janusz; Wierzbicki, Ryszard; Gach, Tomasz; Rutkowski, A.; Dziki, Adam; Kołodziejski, L; Sopyło, Rafał; Pietrzak, L.; Kryński, J; Wiśniowska, Katarzyna; Spałek, Mateusz; Pawlewicz, Konrad; Polkowski, Marcin; Kowalska, Teresa; Paprota, Krzysztof; Jankiewicz, M.; Radkowski, A.; Chałubińska-Fendler, Justyna; Michalski, Wojciech; Bujko, Krzysztof

doi:10.1016/j.radonc.2018.04.004

Cited by 13 publications

(6 citation statements)

References 32 publications

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“…LRR rates of 5%–10% have been reported in other studies following nCRT 27–30 . Notably, the baselines of the two groups in our study were not balanced.…”

Section: Discussioncontrasting

confidence: 51%

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Identification of patients with locally advanced rectal cancer eligible for neoadjuvant chemotherapy alone: Results of a retrospective study

Han

Wang

et al. 2023

Cancer Medicine

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Background and Objectives Neoadjuvant chemotherapy (nCT) appears in a few clinical studies as an alternative to neoadjuvant chemoradiation (nCRT) in selected patients with locally advanced rectal cancer (LARC). We aimed to compare the clinical outcomes of nCT with or without nCRT in patients with LARC and to identify patients who may be suitable for nCT alone. Materials and Methods A total of 155 patients with LARC who received neoadjuvant treatment (NT) were retrospectively analysed from January 2016 to June 2021. The patients were divided into two groups: nCRT (n = 101) and nCT (n = 54). More patients with locally advanced disease (cT4, cN+ and magnetic resonance imaging‐detected mesorectal fascia [mrMRF] positive [+]) were found in the nCRT group. Patients in the nCRT group received a dose of 50 Gy/25 Fx irradiation with concurrent capecitabine, and the median number of nCT cycles was two. In the nCT group, the median number of cycles was four. Results The median follow‐up duration was 30 months. The pathologic complete response (pCR) rate in the nCRT group was significantly higher than that in the nCT group (17.5% vs. 5.6%, p = 0.047). A significant difference was observed in the locoregional recurrence rate (LRR); 6.9% in the nCRT group and 16.7% in the nCT group (p = 0.011). Among patients with initial mrMRF (+) status, the LRR in the nCRT group was significantly lower than that in the nCT group (6.1% vs. 20%, p = 0.007), but not in patients with initial mrMRF negative (−) (10.5% in each group, p = 0.647). Compared with the nCT group, a lower LRR was observed in patients in the nCRT group with initial mrMRF (+) converted to mrMRF (−) after NT (5.3% vs. 23%, p = 0.009). No significant difference was observed between the two groups regarding acute toxicity and overall and progression‐free survivals. Multivariate analysis showed that nCRT and ypN stage were independent prognostic factors for the development of LRR. Conclusion Patients with initial mrMRF (−) may be suitable for nCT alone. However, patients with initial mrMRF (+) converted to mrMRF (−) after nCT are still at high risk of LRR, and radiotherapy is recommended. Prospective studies are required to confirm these findings.

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“…LRR rates of 5%–10% have been reported in other studies following nCRT 27–30 . Notably, the baselines of the two groups in our study were not balanced.…”

Section: Discussioncontrasting

confidence: 51%

“…LRR rates of 5%-10% have been reported in other studies following nCRT. [27][28][29][30] Notably, the baselines of the two groups in our study were not balanced. Although more patients with locally advanced diseases were observed in the nCRT group than in the nCT group, a higher pCR rate and lower LRR were achieved in the nCRT group.…”

Section: Discussionmentioning

confidence: 85%

Identification of patients with locally advanced rectal cancer eligible for neoadjuvant chemotherapy alone: Results of a retrospective study

Han

Wang

et al. 2023

Cancer Medicine

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“…Wait and see project was found with dismal overall survival, local recurrence and distant metastases compared to surgery group after neoadjuvant therapy [14]. Although fewer studies showed local recurrence and survival after short course was worse compared to chemoradiotherapy, recent studies demonstrated similar local control and long term survival with both therapy [15][16][17]. Disease free survival and overall survival rates were not significantly different in short term and long term group of rectal cancer patients by Wang et al [18,19].…”

Section: Discussionmentioning

confidence: 99%

Comparative Evaluation of Preoperative Short Course Radiotherapy Versus Long Course Chemoradiotherapy for the Treatment of Rectal Cancer

Uysal¹

2022

CTOIJ

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family history, inflammatory bowel disease, obesity, processed meat, refined diet, alcohol consumption and smoking are the genetic or enviromental factors of developing colorectal cancer.Management of rectal cancer is considered with surgery as a primary treatment while local recurrence rates vary between 20-50 percent. So dramatic changes were released in recent 20 years. Depth of penetration and regional node involvement are the associated factors for recurrence. Neoadjuvant therapy including chemoradiotherapy, hypofractionated radiotherapy or chemotherapy plus surgery results with better outcomes

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“…In the Dutch CARTS study [chemoradiation therapy for rectal cancer in the distal rectum followed by organ-sparing transanal endoscopic microsurgery (TEMS)], CRT-related complications of at least grade 3 occurred in 23 of 55 patients, and 2 out of 55 toxic deaths were reported [15]. In contrast in the Polish trial [16] 2 out of 138 (1.5%) died during or after the preoperative chemoradiation and prior to surgery and none of the patients during or after 5 × 5 Gy. Similarly in the TROG 0104 trial there was no 30-day operative mortality [14].…”

Section: Introductionmentioning

confidence: 99%

Optimal management of localized rectal cancer in older patients

Bujko

Glynne‐Jones

Papamichael

et al. 2018

Journal of Geriatric Oncology

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Preoperative radiotherapy and local excision of rectal cancer: Long-term results of a randomised study

Cited by 13 publications

References 32 publications

Identification of patients with locally advanced rectal cancer eligible for neoadjuvant chemotherapy alone: Results of a retrospective study

Identification of patients with locally advanced rectal cancer eligible for neoadjuvant chemotherapy alone: Results of a retrospective study

Comparative Evaluation of Preoperative Short Course Radiotherapy Versus Long Course Chemoradiotherapy for the Treatment of Rectal Cancer

Optimal management of localized rectal cancer in older patients

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