Tumor location as an indication for adjuvant radiotherapy in pT3N0 rectal cancer after surgery

Abstract

BackgroundThe optimal care for pT3N0 rectal cancer remains controversial. And whether tumor location can be used to guide the administration of adjuvant radiotherapy for pT3N0 rectal cancer is not fully confirmed. The current study was designed to identify the benefit of adjuvant radiotherapy for pT3N0 rectal cancer.MethodsWe performed a retrospective study of 265 pT3N0 rectal cancer patients who were treated by surgery and adjuvant therapy from Mar. 2005 to Sept. 2015. All patients were divided into two groups according to receiving adjuvant radiotherapy or not. Overall survival (OS), disease-free survival (DFS) were compare between patients who did and did not receive adjuvant radiotherapy. Multivariate analysis was performed to explore clinical factors significantly associated with DFS, local recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS).ResultsFor patients with lower tumor, DFS in adjuvant chemo-radiotherapy group was higher than that in adjuvant chemotherapy group. Besides, the rates of local recurrence and distant metastasis were found lower in patients who did receive adjuvant radiotherapy than those who did not. For patients with upper tumor, the 5-year OS and DFS were similar between groups of adjuvant chemotherapy and adjuvant chemo-radiotherapy. Multivariable analysis indicated both the CEA and tumor location were independent predictors of LRFS. And adjuvant radiotherapy predicted the DFS, LRFS and DMFS in lower rectal cancer patients.ConclusionTumor location can serve as an indication for the administration of adjuvant radiotherapy in pT3N0 rectal cancer patients.

Identification of potential metabolic biomarkers of rectal cancer and of the effect of neoadjuvant radiochemotherapy

“…The consequence is epigenetic changes giving rise to a hypermethylated DNA profile [ 59 ]. In addition, there is a relationship between the location of the tumour and the efficacy of treatment, with distal tumours responding worse [ 60 ]. In our study, the finding that these patients have lower circulating concentrations of fumarate, leucine, and isoleucine could indicate a greater use of these molecules by more metabolically active tumours.…”

Treatment and Outcomes of Colorectal Cancer in Armenia: A Real-World Experience From a Developing Country

“…Our results are discordant with other studies showing improved OS and especially better DFS with neoadjuvant/adjuvant RT. 12 , 51 , 52 In our study group, almost all RT was provided in the adjuvant setting. Therefore, we could not draw any conclusions about whether the situation would have been different if these patients had received neoadjuvant RT.…”

“…Furthermore, we did not have information about exact tumor location in the rectum (low or high) to see whether there was a subgroup of patients who benefited from RT. 52 It is worth mentioning that staging was done mainly with CT scan. Pelvic magnetic resonance imaging or endorectal ultrasound were not used for patients with rectal cancer.…”

Effectiveness of radiotherapy for local control in T3N0 rectal cancer managed with total mesorectal excision: a meta-analysis

“…Adjuvant chemotherapy was received by all study participants in 4 studies but was omitted in the earliest (1980) and only North American study [ 28 ]. Radiotherapy was provided adjuvantly in 3 studies [ 22 , 26 , 27 ] and neoadjuvantly in 2 studies [ 25 , 28 ]. Median follow-up ranged from 41–78 months.…”

“…All studies offered standard fractionated radiotherapy (1.8–2.0 Gy per fraction), with doses ranging from 40 to 60 Gy. Three studies specified their radiotherapy technique as either 3 or 4-field approaches [ 22 , 26 , 28 ] and two others did not specify [ 25 , 27 ]. One neoadjuvant study did not control for margin status [ 28 ], two adjuvant studies included exclusively margin negative patients [ 26 , 27 ], one neoadjuvant study had 5/75 participants in each arm with positive margins (with comparator patients receiving chemoradiotherapy) [ 25 ], and one adjuvant study reported 2/29 comparator participants and 7/122 intervention participants [ 22 ].…”