Postoperative adjuvant chemoradiotherapy in patients with rectal cancer. Prognostic factors for locoregional control and survival

13584 Background: Surgical resection is the cornerstone of curative therapy for rectal cancer. Relapse rate following potentially curative resection is high in patients with stage II/III disease. Thus, chemoradiotherapy is the standard adjuvant treatment in resected stage II/III rectal carcinoma. There are limited studies, if any, analyzing the outcome of rectal cancer patients with stage II/III who received adjuvant chemoradiotherapy after curative resection in Turkey. Therefore, we aimed to analyze the treatment outcome, and the prognostic significance of various parameters in these patients. Methods: 106 patients with stage II/III rectal cancer treated with adjuvant chemoradiotherapy since 1997 until present were analyzed retrospectively. Patients received 5-fluorouracil (370–425mg/m2/day × 5days) and calcium leucovorin (20mg/m2/day × 5days), q4weeks, two courses before and two courses after radiotherapy. The 5-fluorouracil dose was reduced to, 225mg/m2/day given continuously as protracted short-term infusion during radiotherapy. 45–50.4 Gy radiotherapy was given to the pelvic region. Patients were followed-up every 3 months for the first 2 years and every 6 months thereafter. Age, gender, T stage, N stage, histological grade, lymphatic, vascular, and perineural invasion were analyzed as prognostic factors. Results: The median follow-up was 34 months. Median age was 59.5 years. Forty-four percent of the patients were node-negative. Lymphatic, vascular, and perineural invasion rate were 50.5%, 47.3%, and 32.3% respectively. Five-year disease-free and overall survival rates were 68.8% and 72.2%, respectively. Median survival time and median disease free-survival time were not reached at the time of analysis. In multivariate Cox regression analysis; T stage (p: 0.022), nodal stage (0.019), presence of lymphatic invasion (p: 0.0001), and the presence of vascular invasion (p:0.01) were independent prognostic factors. Conclusion: The adjuvant treatment outcome in Turkish patients in our department with stage II/III rectal cancer is similar to those reported in the Western studies. No significant financial relationships to disclose.

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Risk of nodal disease in patients with MRI-detected extramural vascular invasion in rectal cancer: a systematic review and meta-analysis

Tumori Journal ◽

10.1177/0300891620975867 ◽

2020 ◽

pp. 030089162097586

Author(s):

Pratik Tripathi ◽

Zhen Li ◽

Yaqi Shen ◽

Xuemei Hu ◽

Daoyu Hu

Keyword(s):

Systematic Review ◽

Rectal Cancer ◽

Lymph Node ◽

Vascular Invasion ◽

Literature Search ◽

Meta Analysis ◽

Adjuvant Chemoradiotherapy ◽

Cochrane Library ◽

Nodal Disease ◽

The Impact

Background: The impact of magnetic resonance imaging–detected extramural vascular invasion (mrEMVI) in distant metastasis is well known but its correlation with prevalence of lymph node metastasis is less studied. The aim of this systematic review and meta-analysis was to assess the prevalence of nodal disease in mrEMVI–positive and negative cases in rectal cancer. Methods: Following guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic literature search in PubMed, Web of Science, Cochrane Library, and EMBase was carried out to identify relevant studies published up to May 2019. Results: Our literature search generated 10 studies (863 and 1212 mrEMVI–positive and negative patients, respectively). The two groups (mrEMVI–positive and negative) were significantly different in terms of nodal disease status (odds ratio [OR] 3.15; 95% confidence interval [CI] 2.12–4.67; p < 0.001). The prevalence of nodal disease was 75.90% vs 52.56% in the positive mrEMVI vs negative mrEMVI group, respectively ( p < 0.001). The prevalence of positive lymph node in positive mrEMVI patients treated with neoadjuvant/adjuvant chemoradiotherapy (nCRT/CRT) (OR 2.47; 95% CI 1.65–3.69; p < 0.001) was less compared with the patients who underwent surgery alone (OR 6.25; 95% CI 3.74–10.44; p < 0.001). Conclusion: The probability of positive lymph nodes in cases of positive mrEMVI is distinctly greater compared with negative cases in rectal cancer. Positive mrEMVI indicates risk of nodal disease prevalence increased by threefold in rectal cancer.

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