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Journal of Cancer Research and Clinical Oncology

Erschienen in:

01.04.2015 | Original Article - Clinical Oncology

Tailored selection of the interval between neoadjuvant chemoradiotherapy and surgery for locally advanced rectal cancer: analysis based on the pathologic stage or chemoradiation response

verfasst von: Kai-yun You, Rong Huang, Lu-ning Zhang, Pei-rong Ding, Wei-wei Xiao, Bo Qiu, Hui Chang, Zhi-fan Zeng, Zhi-zhong Pan, Yuan-hong Gao

Erschienen in: Journal of Cancer Research and Clinical Oncology | Ausgabe 4/2015

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Abstract

Background

The optimal interval between neoadjuvant chemoradiotherapy (CRT) and surgery has yet to be established. Additionally, it is unknown whether patients with different pathologic stages or chemoradiation responses should undergo different intervals between CRT and surgery. Therefore, the purpose of this study was to evaluate whether this interval has a differential effect on the oncologic outcome of patients with different chemoradiation responses or pathologic stages.

Methods

We performed a retrospective study of 291 rectal cancer patients who were treated with preoperative chemoradiation and surgery between March 2004 and November 2012. All patients were separated into two groups according to a 7-week treatment interval. Overall survival (OS) and disease-free survival (DFS) were compared between patients undergoing intervals that were shorter and longer than 7 weeks in the entire group and in subgroups of ypT0-2N0, ypT3-4N0 and ypT0-4N+. The recurrence patterns were also analysed in all of the subgroups. Multivariate analysis was performed to explore the clinical factors that were significantly associated with DFS, local recurrence-free survival (LRFS) and distant metastasis-free survival among patients exhibiting ypT3-4N0 and ypT0-4N+.

Results

For the ypT0-2N0 patients, the 5-year OS and DFS and the rates of local and distant recurrence were similar between the short and long interval groups. For the patients exhibiting ypT3-4N0, although no significant difference was found in OS or DFS between the short and long interval groups, the rate of local recurrence was higher in the long interval group, which was further confirmed by multivariate analysis. In the patients exhibiting ypT0-4N+, both OS and DFS were lower in the long interval group than in the short interval group. Furthermore, multivariate analysis indicated that the interval was significantly associated with DFS, especially LRFS.

Conclusions

The interval between CRT and surgery may exert a differential effect on the prognosis of patients exhibiting different pathologic stages or chemoradiation responses. Therefore, we strongly suggest tailoring the interval between CRT and surgery in locally advanced rectal cancer.

Bosset JF, Collette L, Calais G et al (2006) Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 355:1114–1123CrossRefPubMed

Das P, Skibber JM, Rodriguez-Bigas MA et al (2007) Predictors of tumor response and downstaging in patients who receive preoperative chemoradiation for rectal cancer. Cancer 109:1750–1755CrossRefPubMed

Foster JD, Jones EL, Falk S et al (2013) Timing of surgery after long-course neoadjuvant chemoradiotherapy for rectal cancer: a systematic review of the literature. Dis Colon Rectum 56(7):921–930CrossRefPubMed

Garcia-Aguilar J, Smith DD, Avila K et al (2011) Optimal timing of Surgery after chemoradiation for advanced rectal cancer: preliminary results of a multicenter nonrandomized phase II prospective trial. Ann Surg 254(1):97–102CrossRefPubMedCentralPubMed

Gerard JP, Conroy T, Bonnetain F et al (2006) Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol 24:4620–4625CrossRefPubMed

Glehen O, Chapet O, Adham M et al (2003) Longterm results of the Lyons R90-01 randomized trial of preoperative radiotherapy with delayed surgery and its effect on sphinctersaving surgery in rectal cancer. Br J Surg 90(8):996–998CrossRefPubMed

Illum H (2011) Irinotecan and radiosensitization in rectal cancer. Anticancer Drugs 22(4):324–329CrossRefPubMed

Jeong DH, Lee HB, Hur H (2013) Optimal timing of surgery after neoadjuvant chemoradiation therapy in locally advanced rectal cancer. J Korean Surg Soc 84(6):338–345CrossRefPubMedCentralPubMed

Kao PS, Chang SC, Wang LW et al (2010) The impact of preoperative chemoradiotherapy on advanced low rectal cancer. J Surg Oncol 102:771–777CrossRefPubMed

Kim CW, Yu CS, Yang SS et al (2011) Clinical significance of pre- to post-chemoradiotherapy s-CEA reduction ratio in rectal cancer patients treated with preoperative chemoradiotherapy and curative resection. Ann Surg Oncol 18:3271–3277CrossRefPubMed

Lim SB, Choi HS, Jeong SY et al (2008) Optimal surgery time after preoperative chemoradiotherapy for locally advanced rectal cancers. Ann Surg 248(2):243–251CrossRefPubMed

Martin ST, Heneghan HM, Winter DC (2012) Systematic review and meta-analysis of outcomes following pathological complete response to neoadjuvant chemoradiotherapy for rectal cancer. Br J Surg 99(7):918–928CrossRefPubMed

National Comprehensive Cancer Network (2013) NCCN clinical practice guidelines in oncology—rectal cancer. http://www.nccn.org/

O’Neill BD, Brown G, Heald RJ et al (2007) Non-operative treatment after neoadjuvant chemoradiotherapy for rectal cancer. Lancet Oncol 8(7):625–633CrossRefPubMed

Park IJ, You YN, Agarwal A et al. (2012) Neoadjuvant treatment response as an early response indicator for patients with rectal cancer. J Clin Oncol 30(15):1770–1776

Park JW, Lim SB, Kim DY et al (2009) Carcinoembryonic antigen as a predictor of pathologic response and a prognostic factor in locally advanced rectal cancer patients treated with preoperative chemoradiotherapy and surgery. Int J Radiat Oncol Biol Phys 74:810–817CrossRefPubMed

Petrelli F, Sgroi G, Sarti E et al (2013) Increasing the interval between neoadjuvant chemoradiotherapy and surgery in rectal cancer: a meta-analysis of published studies. Ann Surg 00:1–8

Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740CrossRefPubMed

Shanmugan S, Arrangoiz R, Nitzkorski JR et al (2012) Predicting pathological response to neoadjuvant chemoradiotherapy in locally advanced Predicting pathological response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer using 18FDG-PET/CT. Ann Surg Oncol 19(7):2178–2185CrossRefPubMed

Sloothaak DA, Geijsen DE, van Leersum NJ et al (2013) Optimal time interval between neoadjuvant chemoradiotherapy and surgery for rectal cancer. Br J Surg 100(7):933–939CrossRefPubMed

Smith KD, Tan D, Das P et al (2010) Clinical significance of acellular mucin in rectal adenocarcinoma patients with a pathologic complete response to preoperative chemoradiation. Ann Surg Oncol 251:261–264CrossRef

Stein DE, Mahmoud NN, Anne PR et al (2003) Longer time interval between completion of neoadjuvant chemoradiation and surgical resection does not improve downstaging of rectal carcinoma. Dis Colon Rectum 46:448–453CrossRefPubMed

Supiot S, Bennouna J, Rio E et al (2006) Negative influence of delayed surgery on survival after preoperative radiotherapy in rectal cancer. Colorectal Dis 8(5):430–435CrossRefPubMed

Tulchinsky H, Shmueli E, Figer A et al (2008) An interval >7 weeks between neoadjuvant therapy and surgery improves pathologic complete response and disease-free survival in patients with locally advanced rectal cancer. Ann Surg Oncol 15(10):2661–2667CrossRefPubMed

Veenhof AA, Kropman RH, Engel AF et al (2007) Preoperative radiation therapy for locally advanced rectal cancer: a comparison between two different time intervals to surgery. Int J Colorectal Dis 22(5):507–513CrossRefPubMed

Veenhof AA, Bloemena E, Engel AF et al (2009) The relationship of histological tumor regression grade (TRG) and two different time intervals to surgery following radiation therapy for locally advanced rectal cancer. Int J Colorectal Dis 24(9):1091–1096CrossRefPubMed

Wolthuis AM, Penninckx F, Haustermans K et al (2011) Outcome standards for an organ preservation strategy in stage II and III rectal adenocarcinoma after neoadjuvant chemoradiation. Ann Surg Oncol 18(3):684–690CrossRefPubMed

Wolthuis AM, Penninckx F, Haustermans K et al (2012) Impact of interval between neoadjuvant chemoradiotherapy and TME for locally advanced rectal cancer on Pathologic response and oncologic outcome. Ann Surg Oncol 19(9):2833–2841CrossRefPubMed

Titel: Tailored selection of the interval between neoadjuvant chemoradiotherapy and surgery for locally advanced rectal cancer: analysis based on the pathologic stage or chemoradiation response
verfasst von: Kai-yun You
Rong Huang
Lu-ning Zhang
Pei-rong Ding
Wei-wei Xiao
Bo Qiu
Hui Chang
Zhi-fan Zeng
Zhi-zhong Pan
Yuan-hong Gao
Publikationsdatum: 01.04.2015
Verlag: Springer Berlin Heidelberg
Erschienen in: Journal of Cancer Research and Clinical Oncology / Ausgabe 4/2015
Print ISSN: 0171-5216
Elektronische ISSN: 1432-1335
DOI: https://doi.org/10.1007/s00432-014-1843-8

Springer Medizin

Tailored selection of the interval between neoadjuvant chemoradiotherapy and surgery for locally advanced rectal cancer: analysis based on the pathologic stage or chemoradiation response