Radiotherapy after local excision of rectal cancer may offer reduced local recurrence rates

Jones, Helen; Goodbrand, Sarah A.; Hompes, Roel; Mortensen, Neil; Cunningham, Chris

doi:10.1111/codi.14546

Cited by 14 publications

(8 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our unit, 33 patients received adjuvant radiotherapy after local excision by TEM for early rectal cancer over a 10-year period. The estimated 3-year local recurrence rate was 6.9% compared with 21.2% in a propensity-score matched group followed by surveillance alone [23]. The standard adjuvant regime was 45 Gy in 25 fractions with oral capecitabine, and, for patients where more limited treatment was indicated, 25 Gy in five fractions without chemotherapy was used.…”

Section: Adjuvant Radiotherapymentioning

confidence: 99%

Adjuvant radiotherapy after local excision of rectal cancer

Jones

Cunningham

2019

Acta Oncologica

Self Cite

View full text Add to dashboard Cite

Background: Local excision is now accepted as a standard treatment option for certain patients with early rectal cancer. However, there is a higher risk of local recurrence than after radical surgery with total mesorectal excision. Adjuvant radiotherapy after local excision may reduce this excess risk, and yet retain the benefits of local excision, with rectal preservation. Methods: A review of the literature pertaining to the use of adjuvant radiotherapy after local excision of rectal cancer and a discussion of current practice. Results: We first considered local excision as a treatment option for early rectal cancer, looking at technical developments and the risks and benefits of organ preservation, in particular, the advantages for quality of life and the risk of leaving residual disease which may result in local recurrence. We then looked at reported outcomes for studies using adjuvant radiotherapy after local excision. Few of the studies routinely used modern endoscopic methods of local excision and only the recent used chemoradiation. Local recurrence rates after adjuvant radiotherapy have improved over time, with rates of around 3.5% in the recent studies. Adverse effects of adjuvant radiotherapy are not commonly described, but generally, they are relatively mild when described. We then discussed current practice regarding adjuvant radiotherapy, including pathological criteria, discussion of local recurrence risk with the patient and the importance of a surveillance regime to detect any recurrence at an early stage. Conclusion: We conclude that the current state of knowledge regarding adjuvant radiotherapy after local excision suggests a potential role in decreasing the risk of local recurrence but further studies are required to better define this effect, clarify which patients will gain the most benefit from this pathway, and identify those who should avoid exposure to the risks of radiotherapy. ARTICLE HISTORY

show abstract

Section: Adjuvant Radiotherapymentioning

confidence: 99%

Adjuvant radiotherapy after local excision of rectal cancer

Jones

Cunningham

2019

Acta Oncologica

Self Cite

View full text Add to dashboard Cite

show abstract

“…The local recurrence of T2 rectal carcinoma is reported to be about 0-37 % with local excision alone and is 0-19 % following a combination of local excision and (chemo-) radiotherapy. Local excision plus additional treatment seems to be effective for local control based on the previous literature [1,2]. Causes of local recurrence include undetected LN metastasis and consequent inadequate chemotherapy, incomplete resection of carcinoma, and implantation of tumor cells [2].…”

Section: Discussionmentioning

confidence: 99%

“…However, major rectal surgery by proctectomy often results in permanent stoma with a significant negative impact on patient-reported outcomes. In addition, postoperative complications, such as disturbed defecation, genitourinary dysfunction, or anastomotic dehiscence, may develop following rectal surgery [1,2]. Local excision, including transanal excision (TAE) and transanal endoscopic microsurgery (TEM), is preferable because it is associated with low morbidity, quick recovery, and minimal effect on long-term bowel function.…”

Section: Introductionmentioning

confidence: 99%

A new procedure combining local resection with endoscopic submucosal dissection for low rectal tumor: a four-case series

et al. 2020

View full text Add to dashboard Cite

Rectal tumors are traditionally resected by proctectomy to ensure the achievement of negative margins, an approach associated with an adverse impact on subsequent quality of life due to sequelae such as permanent stoma and urinary and sexual dysfunction. Many studies have now demonstrated that recurrence after local excision of early rectal tumors is significantly higher than would typically be expected. We have developed a new procedure, described herein, that combines local resection with endoscopic submucosal dissection for low rectal tumor. We report four consecutive cases (three submucosal tumors and one tumor with clinical deep submucosal invasion) treated at Hiroshima City Asa Citizens Hospital between January 2009 and March 2018. The mean duration of the procedure was 137 minutes. The en bloc resection and histologically complete resection rates were 100 %. Delayed bleeding and perforation rates were 0 %. Postoperative complications were fever and anal pain (one case each). All patients recovered with conservative therapy. No recurrence was found in any of the four patients during a follow-up period of 56 months. Our combined endoscopic and surgical procedure for low rectal tumors enabled definite negative vertical margins, reduced tumor volume, allowed for accurate pathological diagnosis, preserved rectal function, and aided the decision on additional therapy.

show abstract

“…Researchers have reported that cancer type, lymphovascular invasion (LVI), depth, and invasion width carry a high recurrence risk [ 11 12 ]. However, adjuvant chemoradiotherapy significantly decreases the incidence of local recurrence [ 13 ]; to achieve this low recurrence rate, multidisciplinary treatment is needed for selected patients and an intensive surveillance program must be implemented [ 14 15 ]. Interestingly, Borstlap et al [ 16 ] reported in their meta-analysis that the local recurrence rates in T1 rectal cancer between patients with TLE with adjuvant therapy and those who underwent radical surgery were comparable.…”

Section: Introductionmentioning

confidence: 99%

Short- and long-term outcomes of local excision with adjuvant radiotherapy in high-risk T1 rectal cancer patients

et al. 2022

View full text Add to dashboard Cite

Purpose The standard of care for early rectal cancer is radical surgery; however, it carries high postoperative morbidity. This study aimed to assess the short-term and oncological outcomes of local excision and adjuvant radiotherapy in patients with high-risk pathological stage (p) T1 rectal cancer. Methods Fifty-five patients underwent local excision with adjuvant radiotherapy or radical resection for high-risk T1 rectal cancer. Patients with adenocarcinoma within 10 cm from the anal verge; pT1 with high-risk features (grade 3–4); a tumor size of ≥3 cm; a positive margin; a lymphovascular or perineural invasion; or a submucosal invasion depth of ≥SM2 were included. Results The rates of postoperative complications and stoma formation were higher in the radical surgery group (P = 0.021 and P = 0.003, respectively). No significant differences were observed in the overall survival and disease-free survival (DFS) between the 2 groups (P = 0.301 and P = 0.076, respectively). Vascular invasion was a significantly poor prognostic factor for DFS (P = 0.033). The presence of 3 or more high-risk features was associated with a poor DFS (P = 0.002). Conclusion Local excision with adjuvant radiotherapy significantly reduces the risk of complications and stoma formation. It is also an alternative option for patients with fewer than 3 high-risk features.

show abstract

Radiotherapy after local excision of rectal cancer may offer reduced local recurrence rates

Cited by 14 publications

References 23 publications

Adjuvant radiotherapy after local excision of rectal cancer

Adjuvant radiotherapy after local excision of rectal cancer

A new procedure combining local resection with endoscopic submucosal dissection for low rectal tumor: a four-case series

Short- and long-term outcomes of local excision with adjuvant radiotherapy in high-risk T1 rectal cancer patients

Contact Info

Product

Resources

About