The effect of postoperative pelvic irradiation after complete resection of metastatic rectal cancer

Chang, Chul; Kim, Hee Cheol; Park, Young Suk; Park, Joon Oh; Choi, Doo Ho; Park, Hee Chul; Cho, Yong Beom; Yun, Seong Hyeon; Lee, Woo Yong; Chun, Ho Kyung

doi:10.1002/jso.22109

Cited by 20 publications

(25 citation statements)

References 28 publications

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“…Although preoperative or postoperative pelvic irradiation has yielded better results in terms of local control for patients with stage II and III rectal cancer [1,2,7], the prognostic roles of these therapies in patients with rectal cancer and metastatic diseases are still unknown. In clinical practice, many oncologists often recommend postoperative chemoradiotherapy for patients with stage IV rectal cancer, in addition to systemic chemotherapy, because pelvic irradiation is believed to possibly strengthen local disease control [3,4,8,9]. However, no definite indications or randomized trials that support this potential role of radiotherapy for this population have been reported to date.…”

Section: Discussionmentioning

confidence: 99%

“…However, no definite indications or randomized trials that support this potential role of radiotherapy for this population have been reported to date. We previously obtained data suggesting that pelvic irradiation might improve local control in patients with stage IV rectal cancer who underwent curative resection; the rate of locoregional recurrence was twice as high in the 40 patients who did not undergo radiotherapy compared with the 28 patients who did undergo postoperative radiotherapy (22.5 and 7.1%, respectively; p = 0.108) [3]. A recent retrospective study also showed that adjuvant pelvic radiotherapy significantly reduced the pelvic failure rate in rectal cancer with synchronous liver metastasis [8].…”

Section: Discussionmentioning

confidence: 99%

“…Sufficient data to guide decisions regarding the best approach in this population have been limited, and until recently, the most appropriate treatment strategy for this population has remained unclear. In our previous work, we observed that postoperative radiotherapy did not confer a significant survival benefit to oncologic outcomes in stage IV rectal cancer [3]. However, the prognostic benefit of preoperative radiotherapy in this population has not yet been examined, nor have the potential benefits of preoperative radiotherapy been compared to those of postoperative radiotherapy.…”

Section: Introductionmentioning

confidence: 99%

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Is Chemoradiotherapy Beneficial for Stage IV Rectal Cancer?

Huh

Kim

Park³

et al. 2015

Oncology

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Purpose: The aim of this study was to investigate the oncologic impact of preoperative or postoperative chemoradiotherapy on stage IV rectal cancer. Methods: A total of 140 consecutive patients with locally advanced mid-to-lower rectal cancer and resectable stage IV disease were prospectively enrolled. In total, 69 patients received chemoradiotherapy (26 preoperatively and 43 postoperatively); in contrast, 71 did not. Survival curves were constructed using the Kaplan-Meier method, and a multivariate analysis was performed to identify independent prognostic factors. Results: According to the multivariate analysis, radiation therapy was not an independent factor associated with either survival or recurrence. The overall survival curves revealed that patients who underwent radiotherapy tended to have a better survival compared with patients who did not undergo radiotherapy; however, this trend was not statistically significant (p = 0.057). The disease-free, local recurrence-free, and distant metastasis-free survival curves did not differ significantly between the two groups. The local recurrence-free survival rates for patients who underwent preoperative radiotherapy were significantly higher than those for patients who underwent postoperative radiotherapy (p = 0.042). Conclusion: Preoperative radiotherapy, rather than postoperative radiotherapy, may improve local control of stage IV rectal cancer. However, chemoradiotherapy did not improve the survival of patients with stage IV rectal cancer in this study.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Is Chemoradiotherapy Beneficial for Stage IV Rectal Cancer?

Huh

Kim

Park³

et al. 2015

Oncology

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“…Most series include patients who had non-surgical management of synchronous metastasis and differences in timing of radiotherapy (10,(15)(16)(17)(18)(19)(20). The most relevant comparisons to our work involve two studies, which investigated the value of RT in patients undergoing curative surgery.…”

Section: Discussionmentioning

confidence: 99%

The role of neoadjuvant radiotherapy for locally-advanced rectal cancer with resectable synchronous metastasis

Fossum¹,

Alabbad²,

Romak³

et al. 2017

J. Gastrointest. Oncol.

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Background: Although neoadjuvant radiotherapy is typically administered for locally-advanced rectal cancer to reduce local recurrence (LR), its role for patients who present with synchronous resectable liver and/or lung metastasis is not well defined. The aim of this study was to evaluate the role of neoadjuvant radiotherapy for patients with stage IV rectal cancer undergoing curative-intent surgery. Methods: This study is a retrospective review of a prospectively maintained surgical registry of all consecutive adult patients who underwent curative-intent resection at Mayo Clinic in Rochester, MN, from January 1990 until December 2014 with a median follow-up time of 43 (IQR 16-67) months. Eligible patients had locally-advanced rectal cancer (T3, T4 and/or nodal involvement) with synchronous resectable liver and/or lung metastasis. Exclusion criteria were as follows: patients with primary tumor stage of T1N0 or T2N0, patients with metastasis to organs other than the liver or lung, patients who had palliative resection, patients who had non-surgical treatment of synchronous metastasis (e.g., radiofrequency ablation), patients who received postoperative radiotherapy, or absence of research authorization. Ninety three patients were included of which 47 received neoadjuvant radiotherapy and 46 did not. All patients received neoadjuvant chemotherapy +/− radiotherapy followed by curative-intent surgery with metastasectomy performed either simultaneously with resection of the primary tumor or as a planned staged resection. The primary outcomes of this study are LR, distant metastasis, overall and disease-specific survival (DSS).Results: LR was observed in 12 patients (26%) who did not receive radiotherapy, while no LR developed in those who received neoadjuvant radiotherapy, P<0.001. Univariate analysis showed that neither age, sex, ASA class, BMI, tumor location, procedure performed, or neoadjuvant chemotherapy were associated with subsequent LR. The 5-year overall survival (OS) rates were: 43.3% (95% CI: 30.1, 62.3) for no radiotherapy vs. 58.3% (95% CI: 43.4, 78.2) with radiotherapy.Conclusions: Neoadjuvant radiotherapy should be considered in patients with locally-advanced stage IV rectal cancer. These data add to the evidence supporting neoadjuvant radiotherapy in the setting of resectable metastatic disease.

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“…Some studies have reported that postoperative pelvic radiotherapy in patients with metastatic rectal cancer does not improve local recurrence and overall outcome [11,12]. The rate of locoregional failure after postoperative radiotherapy in metastatic rectal cancer was 7.1 to 23.1 % compared with 22.5 to 32.6 % of the nonradiation group without significance [12,11].…”

Section: Introductionmentioning

confidence: 95%

Comparison of oncologic outcomes of metastatic rectal cancer patients with or without neoadjuvant chemoradiotherapy

Kim

Jung

2015

Int J Colorectal Dis

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The effect of postoperative pelvic irradiation after complete resection of metastatic rectal cancer

Abstract: Survival benefit of postoperative RTx in stage IV rectal cancer after complete removal of tumors was not apparent. RTx could be recommended for selected patients at high risk of local recurrence or for palliation of symptoms.

Cited by 20 publications

References 28 publications

Is Chemoradiotherapy Beneficial for Stage IV Rectal Cancer?

Is Chemoradiotherapy Beneficial for Stage IV Rectal Cancer?

The role of neoadjuvant radiotherapy for locally-advanced rectal cancer with resectable synchronous metastasis

Comparison of oncologic outcomes of metastatic rectal cancer patients with or without neoadjuvant chemoradiotherapy

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