Outcome of patients with clinical stage II or III rectal cancer treated without adjuvant radiotherapy

495 Background: In the US, patients with clinical stage II/III rectal cancer typically receive neoadjuvant chemoradiation (chemo/XRT) over 5-6 weeks followed by a 6-10 week break before proctectomy. As this chemotherapy is delivered at radio-sensitizing doses, there is essentially a 3-month window during which potential systemic disease is untreated. Evidence regarding the utility of restaging patients prior to proctectomy is limited. Methods: PubMed, Scopus, Web of Science, and the Cochrane Library were searched for studies evaluating the utility of restaging patients with locally advanced rectal cancer after completion of long course chemo/XRT, and reporting changes in management after restaging. Studies that were non-English, included < 50 patients, or examining the diagnostic accuracy of specific imaging modalities were excluded. Study quality was evaluated using the modified Newcastle Ottawa Scale. Results: Eight studies were identified including a total of 1251 patients restaged between completion of chemo/XRT and proctectomy. All studies were retrospective (6 single institution, 2 multi-institution). Restaging identified new metastatic disease in 72 (6.0%) patients, with 4 studies reporting specific sites: liver (n = 28), lung (n = 8), adrenal (n = 1), bone (n = 1), and multiple sites (n = 7). Overall, progression (distant or local) was detected in 85 (6.8%) patients and resulted in a reported change in management in 71 (5.7%) patients. One study identified an association of high-grade tumors with progression (p ≤ 0.05), however, this was not reported in any other study. Moreover, tumor-related prognostic characteristics were inconsistently reported among studies, precluding meta-analysis. Conclusions: Although restaging between completion of neoadjuvant chemo/XRT and proctectomy detects disease progression in only a small percentage of patients, findings may alter the treatment plan. A multi-institutional collaboration with analysis of well-defined prognostic variables may better identify a group of patients most likely to benefit from restaging.

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What Is the Utility of Restaging Imaging for Patients With Clinical Stage II/III Rectal Cancer After Completion of Neoadjuvant Chemoradiation and Prior to Proctectomy?

The American Surgeon ◽

10.1177/0003134820950298 ◽

2020 ◽

pp. 000313482095029

Author(s):

Leah E. Hendrick ◽

Jacob D. Buckner ◽

Whitney M. Guerrero ◽

David Shibata ◽

Nathan M. Hinkle ◽

...

Keyword(s):

Rectal Cancer ◽

Disease Progression ◽

Clinical Stage ◽

Rectal Adenocarcinoma ◽

The United States ◽

Neoadjuvant Chemoradiation ◽

Stage Ii ◽

Surveillance Imaging ◽

Pet Ct ◽

Long Course

Background In the United States, patients with clinical stage II or III rectal cancer typically receive neoadjuvant chemoradiation therapy (chemo/XRT) over a 5-6 week period followed by a 6-10 week break prior to proctectomy. In the current study, we evaluate the utilization of restaging studies performed and detection of disease progression during this window. Methods A retrospective review of patients with clinical stage II/III rectal cancer was performed. Medical records were analyzed to collect clinicopathologic data and the performance and results of preoperative, early postoperative, and first surveillance CT and/or PET/CT in patients completing long course neoadjuvant chemo/XRT and undergoing proctectomy. Results Between 2005 and 2017, 176 patients with clinical stage II or III rectal adenocarcinoma completed neoadjuvant chemo/XRT and underwent proctectomy. Preoperative restaging with CT CAP and/or CT/PET was performed in 72 (40.9%) patients with no detection of disease progression. Of the 104 patients without preoperative restaging, 1 had intraoperative detection of liver metastases and 31 had early postoperative reimaging (within 30 days of proctectomy) of which 2 had detection of new pulmonary metastases. Among 72 patients with no preoperative or early postoperative reimaging, first surveillance imaging was available in 47 and detected new metastases in 8 (17%). Discussion In patients with clinical stage II/III rectal cancer who undergo long course neoadjuvant chemo/XRT, perioperative reimaging with CT CAP and/or PET/CT detects new metastases in a small percentage of patients. A multi-institutional, prospective analysis using standardized staging protocols is warranted to better determine the value of preoperative restaging in these patients.

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IMP3 protein is an independent prognostic factor of clinical stage II rectal cancer

Scientific Reports ◽

10.1038/s41598-021-90513-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Daniela Bevanda Glibo ◽

Danijel Bevanda ◽

Katarina Vukojević ◽

Snježana Tomić

Keyword(s):

Rectal Cancer ◽

Overall Survival ◽

Vascular Invasion ◽

Clinical Stage ◽

Stage Ii ◽

Disease Relapse ◽

Free Interval ◽

Risk Of Disease ◽

Poorly Differentiated ◽

Well Differentiated

AbstractImmunohistochemical level of IMP3-protein in patients with rectal cancer in clinical stage II (141), were correlated with sociodemographic, pathohistological and clinical indicators and duration of overall-survival and progression-free-survival. Vascular invasion was associated with IMP3-positive immunostaining (p < 0.001). Vascular invasion ratio in the group of poorly-differentiated-tumors was 21 times higher than in the group of well-differentiated-tumors. IMP3-positive patients lived 2.2 times shorter than negative (p < 0.001). Patients with well-differentiated-tumors lived 1.7 times longer than the subjects with poorly-differentiated-tumors (p < 0.001). Patients without vascular invasion lived 2.7 times longer than the subjects with vascular invasion (p < 0.001). The risk of mortality was 2.3 times higher for IMP3 positive patients (p = 0.027) and 10.4 higher for the patients with vascular invasion (p < 0.001). IMP3-negative participants had 2.3 times longer free interval without disease (p < 0.001). The free interval without disease was 3.6 times longer in the group without vascular invasion (p < 0.001). The risk of disease relapse in the IMP3 positive group was 5.3 times higher (p < 0.001) and with vascular invasion was 8 times longer (p < 0.001). The risk of disease relapse was 6.8 times higher in the group with vascular invasion (p < 0.001). Patients with rectal cancer and high IMP3-protein level will have a shorter overall survival relative to patients without or with low levels of IMP3. The analysis of IMP3 expression by immunohistochemistry pointed IMP3 as an independent prognostic factor of clinical stage II rectal cancer.

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A Predictive Genetic Signature for Response to Fluoropyrimidine-Based Neoadjuvant Chemoradiation in Clinical Stage II and III Rectal Cancer

Frontiers in Oncology ◽

10.3389/fonc.2013.00288 ◽

2013 ◽

Vol 3 ◽

Cited By ~ 3

Author(s):

Jason Chan ◽

Michael T. Kinsella ◽

Joseph E. Willis ◽

Huankai Hu ◽

Harry Reynolds ◽

...

Keyword(s):

Rectal Cancer ◽

Clinical Stage ◽

Neoadjuvant Chemoradiation ◽

Stage Ii ◽

Genetic Signature

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Upfront radical surgery with total mesorectal excision (TME) versus preoperative chemoradiotherapy followed by TME in clinical stage II/III patients with rectal cancer: A propensity score analysis

Annals of Oncology ◽

10.1093/annonc/mdz246.018 ◽

2019 ◽

Vol 30 ◽

pp. v205

Author(s):

A. Ham ◽

H.S. Kim ◽

J.S. Chang ◽

S.J. Shin ◽

S.-H. beom ◽

...

Keyword(s):

Rectal Cancer ◽

Propensity Score ◽

Total Mesorectal Excision ◽

Radical Surgery ◽

Propensity Score Analysis ◽

Clinical Stage ◽

Preoperative Chemoradiotherapy ◽

Stage Ii ◽

Mesorectal Excision ◽

Score Analysis

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A comparison of overall and disease-specific survivals following adjuvant radiotherapy with neo-adjuvant radiotherapy for rectal cancer

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e15008 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e15008-e15008 ◽

Cited By ~ 1

Author(s):

I. Ahmed ◽

M. Howard ◽

Z. Rehman ◽

F. Ofar ◽

P. Marley ◽

...

Keyword(s):

Rectal Cancer ◽

Adjuvant Radiotherapy ◽

Preoperative Radiotherapy ◽

Postoperative Radiotherapy ◽

Stage Ii ◽

Disease Specific Survival ◽

Rectosigmoid Junction ◽

Kaplan Meier ◽

Hazard Ratios ◽

Disease Specific

e15008 Background: Preoperative radiotherapy is the preferred treatment for stage II-III rectal cancer. This arose following publication of the results of the German Rectal Cancer Study Group. It demonstrated a statistically significantly reduced local recurrence rate, and reduced toxicity for preoperative treatment compared with postoperative treatment. However, it failed to demonstrate improved overall survival. This study used the Surveillance, Epidemiology, and End Results (SEER) Program to compare overall and disease specific survival in rectal cancer patients treated with preoperative versus those receiving postoperative radiotherapy. Methods: 14,553 patients were identified with stage II-III rectal cancer, treated with either preoperative (5,136 patients) or postoperative radiotherapy (9,417 patients). Kaplan-Meier survival analyses and Cox multivariate analyses were used to compare 5 and 10 year overall and disease specific survival rates. Cause of death (COD) recorded as ‘Rectum and Rectosigmoid Junction’ was used to calculate rectal-specific survival. CODs recorded as ‘Colon excluding Rectum’ and ‘Rectum and Rectosigmoid Junction’ were used for colorectal-specific survival. Results: Kaplan-Meier analysis failed to demonstrate any statistical significant differences in survival figures. Cox multivariate analysis returned hazard ratios for overall survival of 1.207 (95% CI 1.122 - 1.298) and 1.180 (95% CI 1.103 - 1.263) at 5 and 10 years respectively for preoperative radiotherapy when compared with postoperative radiotherapy. For rectal-specific survival, 5 and 10 year hazard ratios of 1.381 (95% CI 1.239 - 1.539) and 1.342 (95% CI 1.210 - 1.489) respectively were obtained. Colorectal-specific survival returned 5 and 10 year hazard ratios of 1.222 (95% CI 1.124 - 1.329) and 1.193 (95% CI 1.101–1.292) respectively. Conclusions: Preoperative radiotherapy is the preferred treatment for stages II-III rectal cancer. This is because of its decreased risk of local recurrence and more optimal toxicity profile. However, this study suggests that preoperative radiotherapy is associated with poorer survival when compared with postoperative radiotherapy in the treatment of stage II-III rectal cancer. No significant financial relationships to disclose.

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