Clinical staging accuracy and the use of neoadjuvant chemoradiotherapy for cT3N0 rectal cancer: Propensity score matched National Cancer Database analysis

2020 ◽  
Author(s):  
Dominykas Burneikis ◽  
Olga Lavryk ◽  
Emre Gorgun ◽  
David Liska ◽  
Michael Valente ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Propensity Score ◽  
Neoadjuvant Chemoradiotherapy ◽  
Clinical Staging ◽  
National Cancer Database ◽  
Database Analysis ◽  
Staging Accuracy

Upfront surgery, neoadjuvant, and definitive chemoradiation for clinical T2N0 esophageal adenocarcinoma: A propensity score matched analysis from the National Cancer Database analysis.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 103-103
Author(s):  
Ravi Shridhar ◽  
Jamie Huston ◽  
Kenneth L Meredith
Keyword(s):  
Overall Survival ◽  
Propensity Score ◽  
Esophageal Adenocarcinoma ◽  
Neoadjuvant Chemoradiation ◽  
Clinical Staging ◽  
National Cancer Database ◽  
High Grade ◽  
Database Analysis ◽  
Tumor Length ◽  
Definitive Chemoradiation

103 Background: To compare overall survival (OS) of T2N0 esophageal adenocarcinomas treated with either upfront surgery (US), neoadjuvant chemoradiation (NCR), or definitive chemoradiation (DCR) from the National Cancer Database (NCDB). Methods: The NCDB was accessed to identify patients with T2N0 esophageal adenocarcinoma treated between 2004-2013 with either US, NCR, or DCR. NCR and DCR patients were included if they were treated with a radiation dose between 45-50.4 Gy and received chemotherapy. Propensity score matching (PSM) was performed against age and tumor length. Results: After PSM, 446 patients (US 98; NCR 203; DCR 145) were included in the analysis. There was no difference in age, tumor length, and grade. Clinical staging in US patients was accurate pathologically in 32.6% of patients. Median and 5 year OS for US, NCR, and DCR patients was 42.5 months and 40%, 48.5 months and 48%, and 22.9 months and 20%, respectively (p<0.001). There was no difference in OS based on response to NCR compared to US. NCR was associated with improved OS in patients with tumors >3 cm compared to US (median OS 43.8 versus 36.4 months; p=0.01). There was a trend toward improved OS with NCR in high grade tumors compared to US. UVA and MVA of OS revealed that DCR was associated with worse survival. Conclusions: Clinical staging for T2N0 esophageal adenocarcinoma continues to remain highly inaccurate. There was no difference in OS between US and NCR, however, improved OS was seen in NCR patients with tumors >3 cm.

Deferral of rectal surgery following a continued response to preoperative chemoradiotherapy (Watch and Wait) study: A phase II multicenter study in the United Kingdom.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 489-489 ◽  
Author(s):  
S. K. Yu ◽  
G. Brown ◽  
R. J. Heald ◽  
S. Chua ◽  
G. Cook ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Surgical Resection ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Neoadjuvant Chemoradiotherapy ◽  
Complete Response ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Clinical Staging ◽  
Pet Ct

489 Background: Neoadjuvant chemoradiotherapy (CRT) and surgical resection are standard components of therapy for patients locally advanced rectal cancer (T3,T4 or N+) in UK. In 15%-30% of patients treated pre-operatively with CRT will develop pathological complete response (CR). The time from completion of CRT to maximal tumour response is as yet unknown. This study is the first prospective study to attempt to identify the percentage of patients who can safely omit surgery and the safety of deferred surgery in patients who achieve clinical complete response post CRT. Of the 59 patients required for the study, this provides an update on 19 patients entered. Methods: Patients with locally advanced rectal cancer requiring neoadjuvant treatment are identified in the multidisciplinary meet (MDT). Patients undergo CRT using a minimum of 50.4Gy in 28 # daily conformal CT planned CRT with concomitant Capecitabine at 825mg/m2 BD. MRI pelvis and body CT are repeated 4 weeks post CRT and rediscussed at MDT. If there is a good partial response or CR, patients are considered for Deferral of Surgery Study. Based on the pre treatment clinical staging, patients are considered for adjuvant chemotherapy as per NICE guidance. At any point of the study, if there is histology proven tumour regrowth or progression, patient undergo surgery. Results: 10 (53%) patients remain in CR. 6 (32%) patients underwent surgical resection with clear margin after detection of tumour regrowth at from 2-23 months post CRT. 5 out of 6 of the patients with tumour regrowth underwent PET CT as per protocol, and all tumour regrowth in those 5 patients were detected by PET CT, i.e. FDG avid disease. The pathological stages on these 6 patients were ypT2N0 CRM negative in 5 and ypT3N0 CRM negative in 1. 3 (15%) patients with tumour regrowth refused surgery. Conclusions: In the 19 recruited patients, all the patients with tumour regrowth underwent surgical resection with clear margins. PET CT appears a useful tool for detecting tumour regrowth. The median time for tumour regrowth is 17.5 months post CRT. The trial will be successful if at least 11/59 patients are able to safely omit surgery. Accrual of patients continues. No significant financial relationships to disclose.

scholarly journals Trends in intensity-modulated radiation therapy use for rectal cancer in the neoadjuvant setting: a National Cancer Database analysis

2018 ◽  
Vol 36 (4) ◽  
pp. 276-284 ◽  
Author(s):  
Rodney E. Wegner ◽  
Stephen Abel ◽  
Richard J. White ◽  
Zachary D. Horne ◽  
Shaakir Hasan ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Radiation Therapy ◽  
Intensity Modulated Radiation Therapy ◽  
National Cancer Database ◽  
Database Analysis ◽  
Intensity Modulated

scholarly journals Oncologic results in rectal cancer patients with a subcentimeter distal margin after laparoscopic-assisted sphincter-preserving surgery: a propensity-score matched cohort analysis

2020 ◽  
Author(s):  
Chenghai Zhang ◽  
Hong Yang ◽  
Ming Cui ◽  
Jiadi Xing ◽  
Zhendan Yao ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Cancer Patients ◽  
Cohort Analysis ◽  
Neoadjuvant Chemoradiotherapy ◽  
Distal Margin ◽  
Rectal Cancers ◽  
Laparoscopic Assisted ◽  
The Impact

Abstract Background: Distal resection margin (DRM) is closely associated with sphincter-preserving surgery and oncologic safety for patients with mid-low rectal cancers. However, the optimal DRM has not been determined. The purpose of this study to assess the impact of a DRM of ≤ 1 cm on oncologic safetyMethods: Data of 378 rectal cancer patients who underwent laparoscopic-assisted sphincter-preserving surgery from 2009 to 2015 were retrospectively analyzed. Patients were divided into two groups based on DRM: ≤ 1 cm (n=74) and >1 cm (n=304). To minimize the differences between the two groups, propensity-score matching on baseline features was performed. Stratified analysis was performed according to neoadjuvant chemoradiotherapy.Results: Before propensity-score matching, no significant differences in 5-year disease-free survival (DFS) (92.8 vs. 81.3%; P=0.128) and 5-year overall survival (OS) (83.7 vs. 82.2%; p=0.892) were observed in patients with DRMs of ≤1(n=74) and >1cm (n=304), respectively. After propensity-score matching (1:1), there were also no significant differences in DFS (88.1 vs. 78.2%; P=0.162) and OS (84.5vs. 84.9%; P=0.420) between the DRM of ≤1 cm group (n=65) and >1 cm group (n=65), respectively. A total of 44 patients received preoperative chemoradiotherapy. In this cohort, the 5-year local recurrence (LR) rates ( p=0.118) and the 5-year DFS rates ( p=0.298) were not significantly different between two groups. A total of 334 patients received surgery without neoadjuvant chemoradiotherapy. There were also no significant differences in the 5-year LR rates ( p=0.150) and 5-year DFS rates ( p=0.172) between two groups.Conclusions: No matter whether patients with rectal cancers receiving neoadjuvant therapy or not, sphincter-preserving surgery with a DRM of ≤1 cm may be acceptable in mid-low rectal cancer without jeopardizing oncologic safety.

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