Proton beam therapy in rectal cancer: A systematic review and meta-analysis

Fok, Matthew; Toh, Steven; Easow, Jeremy; Fowler, Hayley; Clifford, Rachael; Parsons, Jason L.; Vimalachandran, Dale

doi:10.1016/j.suronc.2021.101638

Cited by 11 publications

(7 citation statements)

References 52 publications

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“…Striking a balance between the advantages of neoadjuvant and adjuvant chemoradiation therapy, considering the risk of complications, and aiming for stoma reversal should be a key consideration. Furthermore, proton beam therapy is less invasive for rectal cancer compared to photon-based radiotherapy [41]. The future treatment plan can also consider proton therapy to achieve preferable outcomes.…”

Section: Discussionmentioning

confidence: 99%

Predictors for Temporary Stomas Non-Closure among Non-Metastatic Rectal Cancer Patients Undergoing Curative Resection: a Retrospective Analysis

Hsu,

Tsai,

Tsai

et al. 2024

Preprint

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Background: The primary treatment for non-metastatic rectal cancer is curative resection. However, sphincter-preserving surgery may lead to complications. This study aims to develop a predictive model for stoma non-closure in rectal cancer patients who underwent curative-intent restorative proctectomy surgery. Methods: Consecutive patients diagnosed with non-metastatic rectal cancer between January 2005 and December 2017, who underwent proctectomy, were retrospectively included in the Chang Gung Memorial Foundation Institutional Review Board. A comprehensive evaluation and analysis of potential risk factors linked to stoma non-closure were performed. Results: Out of 956 patients with temporary stomas, 10.3% (n = 103) experienced non-closure primarily due to cancer recurrence and anastomosis-related issues. Through multivariate analysis, several preoperative risk factors significantly associated with stoma non-closure were identified, including advanced age, anastomotic leakage, positive nodal status, high preoperative CEA levels, lower rectal cancer presence, margin involvement, and an eGFR below 30 mL/min/1.73m2. A risk assessment model achieved an AUC of 0.724, with a cutoff of 2.5, 84.5% sensitivity, and 51.4% specificity. Importantly, the non-closure rate could rise to 16.6% when more than two risk factors were present, starkly contrasting the 3.7% non-closure rate observed in cases with a risk score of 2 or below (p < 0.001). Conclusion: Prognostic risk factors associated with the non-closure of a temporary stoma include advanced age, symptomatic anastomotic leakage, nodal status, high CEA levels, margin involvement, and an eGFR below 30 mL/min/1.73m2. Hence, it is crucial for surgeons to evaluate these factors and provide patients with a comprehensive prognosis before undergoing surgical intervention.

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Section: Discussionmentioning

confidence: 99%

Predictors for Temporary Stomas Non-Closure among Non-Metastatic Rectal Cancer Patients Undergoing Curative Resection: a Retrospective Analysis

Hsu,

Tsai,

Tsai

et al. 2024

Preprint

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show abstract

“…This study and our report show that current chemoradiation therapy has limited advantage in improving organ preservation. Furthermore, proton beam therapy is less invasive for rectal cancer compared to photon-based radiotherapy [ 32 ]. Therefore, the application of proton therapy in rectal cancer may have the potential benefit of improving tumor control and organ preservation Additionally, adjuvant chemotherapy was identified as a protective factor against stoma non-closure (OR: 0.26, p < 0.001).…”

Section: Discussionmentioning

confidence: 99%

Predictors for temporary stomas non-closure among non-metastatic rectal cancer patients undergoing curative resection: a retrospective analysis

Hsu,

Tsai,

Tsai

et al. 2024

World J Surg Onc

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Background The primary treatment for non-metastatic rectal cancer is curative resection. However, sphincter-preserving surgery may lead to complications. This study aims to develop a predictive model for stoma non-closure in rectal cancer patients who underwent curative-intent low anterior resection. Methods Consecutive patients diagnosed with non-metastatic rectal cancer between January 2005 and December 2017, who underwent low anterior resection, were retrospectively included in the Chang Gung Memorial Foundation Institutional Review Board. A comprehensive evaluation and analysis of potential risk factors linked to stoma non-closure were performed. Results Out of 956 patients with temporary stomas, 10.3% (n = 103) experienced non-closure primarily due to cancer recurrence and anastomosis-related issues. Through multivariate analysis, several preoperative risk factors significantly associated with stoma non-closure were identified, including advanced age, anastomotic leakage, positive nodal status, high preoperative CEA levels, lower rectal cancer presence, margin involvement, and an eGFR below 30 mL/min/1.73m2. A risk assessment model achieved an AUC of 0.724, with a cutoff of 2.5, 84.5% sensitivity, and 51.4% specificity. Importantly, the non-closure rate could rise to 16.6% when more than two risk factors were present, starkly contrasting the 3.7% non-closure rate observed in cases with a risk score of 2 or below (p < 0.001). Conclusion Prognostic risk factors associated with the non-closure of a temporary stoma include advanced age, symptomatic anastomotic leakage, nodal status, high CEA levels, margin involvement, and an eGFR below 30 mL/min/1.73m2. Hence, it is crucial for surgeons to evaluate these factors and provide patients with a comprehensive prognosis before undergoing surgical intervention.

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“…There are several studies demonstrating dosimetric advantages for protons in the pelvic area [22] , [33] , [34] , [35] , [36] . A recent metanalysis [37] showed improved dosimetric radiation profile with PBT compared to intensity modulated radiation therapy (IMRT) in treatment of rectal cancer. However, no comparative planning studies have previously been done as part of the ongoing randomized PBT clinical trial in rectal cancer .…”

Section: Discussionmentioning

confidence: 99%

Preoperative short-course radiation therapy with PROtons compared to photons in high-risk RECTal cancer (PRORECT): Initial dosimetric experience

Pedone

Sorcini

Staff

et al. 2023

Clinical and Translational Radiation Oncology

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Proton beam therapy in rectal cancer: A systematic review and meta-analysis

Cited by 11 publications

References 52 publications

Predictors for Temporary Stomas Non-Closure among Non-Metastatic Rectal Cancer Patients Undergoing Curative Resection: a Retrospective Analysis

Predictors for Temporary Stomas Non-Closure among Non-Metastatic Rectal Cancer Patients Undergoing Curative Resection: a Retrospective Analysis

Predictors for temporary stomas non-closure among non-metastatic rectal cancer patients undergoing curative resection: a retrospective analysis

Preoperative short-course radiation therapy with PROtons compared to photons in high-risk RECTal cancer (PRORECT): Initial dosimetric experience

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