Comparison of Treatment Outcomes in Patients with Rectal Cancer

Objective: The aim of the present study is to evaluate survival results and acute chemoradiotherapy toxicity in patients with rectalcancer who underwent preoperative chemoradiotherapy (CRT), postoperative CRT, and non-operative CRT.Methods: The records of 139 patients with rectal cancer were analyzed retrospectively. Out of these, the data 9 (6%) patients whodied during or immediately after treatment and 2 (1%) patients who gave up the treatment were not used in the survival analysis.Results: Postoperative CRT was applied to 57 (44%) patients, preoperative CRT to 47 (37%) patients, and non-operative CRT to 24(19%) patients. Non-operative CRT group was the oldest patient group (median age: 70). There was a difference between the treatment groups regarding tumor localization (p

PDF

___

1. Haggar FA, Boushey RP . Colorectal cancer epidemiology: incidence, mortality, survival, and risk factors. Clin Colon Rectal Surg 2009; 22: 191-7. [CrossRef]
2. Gunderson Leonard and Tepper JE. Clinical Radiation Oncology. 4th ed. Elsevier Publishers, 2015.
3. NIH consensus conference. Adjuvant therapy for patients with colon and rectal cancer. JAMA 1990; 264: 1444–50. [CrossRef]
4. Colorectal Cancer Collaborative Group. Adjuvant radiotherapy for rectal cancer: a systematic overview of 8,507 patients from 22 randomised trials. Lancet 2001; 358: 1291-304. [CrossRef]
5. Pasetto LM, Pucciarelli S, Agostini M, Rossi E, Monfardini S. Neoadjuvant treatment for locally advanced rectal carcinoma. Crit Rev Oncol Hematol 2004; 52: 61-71. [CrossRef]
6. Fisher B, Wolmark N, Rockette H, Redmond C, Deutsch M, Wickerham DL, et al. Postoperative radiation therapy for rectal cancer: Results from NSABP protocol R-01. J Natl Cancer Inst 1988; 80: 21-9. [CrossRef]
7. Thomas PR, Lindblad AS. Adjuvant postoperative radiotherapy and chemotherapy in rectal carcinoma: A review of the Gastrointestinal Tumor Study Group experience. Radiother Oncol 1988; 13: 245-52. [CrossRef]
8. Braendengen M, Tveit KM, Berglund A, Birkemeyer E, Frykholm G, Påhlman L, et al. Randomized phase III study comparing preoperative radiotherapy with chemoradiotherapy in nonresectable rectal cancer. J Clin Oncol 2008; 26: 3687-94. [CrossRef]
9. Bosset JF, Calais G, Mineur L, Maingon P, Radosevic-Jelic L, Daban A, et al. Enhanced tumoricidal effct of chemotherapy with preoperative radiotherapy for rectal cancer: preliminary results-EORTC 22921. J Clin Oncol 2005; 23: 5620-7. [CrossRef]
10. Bosset JF, Calais G, Mineur L, Maingon P, Stojanovic-Rundic S, Bensadoun RJ, et al. Fluorouracil-based adjuvant chemotherapy after preoperative chemoradiotherapy in rectal cancer: long-term results of the EORTC 22921 randomized study. Lancet Oncol 2014; 15: 184- 90. [CrossRef]
11. Gérard JP, Conroy T, Bonnetain F, Bouché O, Chapet O, Closon-Dejardin MT, et al. Preoperative radiotherapy with or without concurrent florouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol 2006; 24: 4620-5. [CrossRef]
12. Roh MS, Colangelo LH, O’Connell MJ, Yothers G, Deutsch M, Allegra CJ, et al. Preoperative multimodality therapy improves disease-free survival in patients with carcinoma of the rectum: NSABP R-03. J Clin Oncol 2009; 27: 5124-30. [CrossRef]
13. Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N England J Med 2004; 351: 1731-40. [CrossRef]
14. Sauer R, Liersch T, Merkel S, Fietkau R, Hohenberger W, Hess C, et al. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of German CAO/ARO/AIO-94 phase III trial after a median follow-up of 11 years. J Clin Oncol 2012; 30: 1926-33. [CrossRef]
15. Demircioglu F, Diclehan K. Radiation therapy schedule for rectal cancer. Turkish Journal of Oncology 2014; 29: 57-66. [CrossRef]
16. Glynne-Jones R, Sebag-Montefire D. Chemoradiation schedules what radiotherapy?. Eur J Cancer 2002; 38: 258-69. [CrossRef]
17. Sebag-Montefire D, Stephens RJ, Steele R, Monson J, Grieve R, Khanna S, et al. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): A multicentre, randomized trial. Lancet 2009; 373: 811-20. [CrossRef]
18. Schaffr M, Thoma M, Wilkowski R, Schaffr P, Dühmke E. Radio-chemotherapy as a preoperative treatment for advanced rectal cancer. Evaluation of down-staging and morbidity. Onckologie 2002; 25: 352-6. [CrossRef]
19. Wheeler JM, Dodds E, Warren BF, Cunningham C, George BD, Jones AC, et al. Preoperative chemoradiotherapy and total mesorectal exicision surgery for locally advanced rectal cancer: coorrelation with rectal cancer regression grade. Dis Colon Rectum 2004; 47: 2025-31. [CrossRef]
20. Grann A, Minsky BD, Cohen AM, Saltz L, Guillem JG, Paty PB, et al. Preliminary results of preoperative 5-florouracil, low-dose leucovorin, and concurrent radiation therapy for clinically resectable T3 rectal cancer. Dis Colon Rectum 1997; 40: 515-22. [CrossRef]
21. Guillem JG, Chessin DB, Cohen AM, Shia J, Mazumdar M, Enker W, et al. Long-term oncologic outcome following preoperative combined modality therapy and total mesorectal excision of locally advanced rectal cancer. Ann Surg 2005; 241: 829-36. [CrossRef]
22. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 2010; 17: 1471-4. [CrossRef]
23. RTOG/EORTC Late Radiation Morbidity Scoring Schema. Available from: URL: https://www.rtog.org/ (cited 2017 february 21).
24. Meterissian S, Skibber J, Rich T, Roubein L, Ajani J, Cleary K, et al. Patterns of residual disease after preoperative chemoradiation in ultrasound T3 rectal carcinoma. Ann Surg Oncol 1994; 1: 111-6. [CrossRef]
25. Habr-Gama A, Perez RO, Nadalin W, Sabbaga J, Ribeiro U Jr, Silva e Sousa AH Jr, et al. Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: longterm results. Ann Surg 2004; 240: 711-8. [CrossRef]
26. Habr-Gama A, Sabbaga J, Gama-Rodrigues J, São Julião GP, Proscurshim I, Bailão Aguilar P, et al. Watch and wait approach following extended neoadjuvant chemoradiation for distal rectal cancer: are we getting closer to anal cancer management? Dis Colon Rectum 2013; 56: 1109-17. [CrossRef]
27. Renehan AG, Malcomson L, Emsley R, Gollins S, Maw A, Myint AS, et al. Watch-and-wait approach versus surgical resection after chemoradiotherapy for patients with rectal cancer (the OnCoRe project): a propensity-score matched cohort analysis. Lancet Oncol 2016; 17: 174-83. [CrossRef]
28. Krook JE, Moertel CG, Gunderson LL, Wieand HS, Collins RT, Beart RW, et al. Effctive surgical adjuvant therapy for high-risk rectal carcinoma. N Eng J Med 1991; 324: 709-15. [CrossRef]
29. Gastrointestinal Tumor Study Group. Prolongation of the disease-free interval in surgically treated rectal carcinoma. N Eng J Med 1985; 312: 1465-72. [CrossRef]
30. Hyams DM, Mamounas EP, Petrelli N, Rockette H, Jones J, Wieand HS, et al. A clinical trial to evaluate the worth of preoperative multimodality therapy in patients with operable carcinoma of the rectum: a progress report of National Surgical Breast and Bowel Project Protocol R-03. Dis Colon Rectum 1997; 40: 131-9. [CrossRef]
31. Park JH, Yoon SM, Yu CS, Kim JH, Kim TW, Kim JC. Randomized phase 3 trial comparing preoperative and postoperative chemoradiotherapy with capecitabine for locally advanced rectal cancer. Cancer 2011; 117: 3703-12. [CrossRef]