scholarly journals Impact of the distal resection margin on local recurrence after neoadjuvant chemoradiation and rectal excision for locally advanced rectal cancer

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Seung Ho Song ◽  
Jun Seok Park ◽  
Gyu-Seog Choi ◽  
An Na Seo ◽  
Soo Yeun Park ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Resection Margin ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Preoperative Chemoradiotherapy ◽  
Locally Advanced Rectal Cancer ◽  
Distal Resection Margin ◽  
Recurrence Rates ◽  
Tumor Stages

AbstractWe aimed to evaluate whether a short distal resection margin (< 1 cm) was associated with local recurrence in patients with locally advanced rectal cancer who underwent preoperative chemoradiotherapy. Patients with rectal cancer who underwent preoperative chemoradiotherapy followed by curative surgery were divided into two groups based on the distal resection margin (≥ 1 cm and < 1 cm). In total, 507 patients were analyzed. The median follow-up duration was 48.9 months. The 3-year local recurrence rates were 2% and 8% in the ≥ 1 cm and < 1 cm groups, respectively (P < 0.001). Multivariable analysis revealed that a distal resection margin of < 1 cm was a significant risk factor for local recurrence (P = 0.008). Subgroup analysis revealed that a distal resection margin of < 1 cm was not an independent risk factor for local recurrence in the ypT0–1 group. However, among patients with tumor stages ypT2–4, the cumulative 3-year incidences of local recurrence were 2.3% and 9.8% in the ≥ 1 cm and < 1 cm groups, respectively (P = 0.01). A distal resection margin of < 1 cm might influence local recurrence rates in patients with locally advanced rectal cancer undergoing preoperative chemoradiotherapy, especially in patients with tumor stages ypT2–4.

scholarly journals Impact of The Distal Resection Margin On Local Recurrence After Neoadjuvant Chemoradiation and Rectal Excision For Locally Advanced Rectal Cancer

2021 ◽  
Author(s):  
Seung Ho Song ◽  
Jun Seok Park ◽  
Gyu-Seog Choi ◽  
An Na Seo ◽  
Soo Yeun Park ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Resection Margin ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Preoperative Chemoradiotherapy ◽  
Locally Advanced Rectal Cancer ◽  
Distal Resection Margin ◽  
Recurrence Rates ◽  
Tumor Stages

Abstract We aimed to evaluate whether a short distal resection margin (< 1 cm) was associated with local recurrence in patients with locally advanced rectal cancer who underwent preoperative chemoradiotherapy. Patients with rectal cancer who underwent preoperative chemoradiotherapy followed by curative surgery were divided into two groups based on the distal resection margin (≥ 1 cm and < 1 cm). In total, 507 patients were analyzed. The median follow-up duration was 48.9 months. The 3-year local recurrence rates were 2% and 8% in the ≥ 1 cm and < 1 cm groups, respectively (p < 0.001). Multivariable analysis revealed that a distal resection margin of < 1 cm was a significant risk factor for local recurrence (p = 0.008). Subgroup analysis revealed that a distal resection margin of < 1 cm was not an independent risk factor for local recurrence in the ypT0–1 group. However, among patients with tumor stages ypT2–4, the cumulative 3-year incidences of local recurrence were 2.3% and 9.8% in the ≥ 1 cm and < 1 cm groups, respectively (p = 0.001). A distal resection margin of < 1 cm might influence local recurrence rates in patients with locally advanced rectal cancer undergoing preoperative chemoradiotherapy, especially in patients with tumor stages ypT2–4.

Randomized phase II trial of preoperative chemoradiotherapy with or without cetuximab in locally advanced rectal adenocarcinoma.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 537-537 ◽  
Author(s):  
A. David McCollum ◽  
Darren M. Kocs ◽  
Punit Chadha ◽  
Michael A. Monticelli ◽  
Thomas E. Boyd ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Locally Advanced ◽  
Rectal Adenocarcinoma ◽  
Advanced Rectal Cancer ◽  
Preoperative Chemoradiotherapy ◽  
Locally Advanced Rectal Cancer ◽  
Preoperative Radiation ◽  
Pelvic Radiotherapy ◽  
Recurrence Rates ◽  
Grade 3

537 Background: Treatment for locally advanced rectal cancer (LARC) includes preoperative radiation concurrent with fluoropyrimidine chemotherapy (CRT). Local recurrence is a problem. Cetuximab is active in colorectal cancer and is effective with radiotherapy in other diseases. This study evaluated the pathologic response rate for LARC treated with preoperative chemoradiotherapy w/wo cetuximab. Methods: LARC (T3/4 or LN+, M0) pts were randomized to Arm1/Arm2. Arm 1 received standard pelvic radiotherapy (5040-5400cGy in daily fractions) with continuous infusional 5-FU (225mg/m2/day); Arm 2 received identical chemoradiotherapy + concurrent cetuximab (400mg/m2 initial dose) 1 week before pelvic radiotherapy, followed by 250mg/m2 weekly for the duration of chemoradiotherapy. After study treatment completion, pts were re-evaluated clinically and radiographically for clinical response. After 6-8 weeks, patients underwent surgical resection. The primary end point was pathologic CR (pCR), and secondary endpoints included ORR, RFS, OS, and local recurrence rates. Results: 139 pts were enrolled (Arm 1=69/Arm2=70); Arm1/Arm2 median age 61/55 yrs, and stage II and III 59%, 39%/40%, 60%. In 124 postsurgery pts, pCR occurred in 17 Arm 1 pts (28.3%, 95% CI 17.5-41.4) and 17 Arm 2 pts (26.6%, 95% CI 16.3-39.1); TRG postsurgery was similar between treatment arms (Table). Grade 3 and 4 toxicities were largely nonhematologic: diarrhea 16%/22%, rash 0%/12%, dehydration 5%/8%, mucositis 5%/6%. The 5-yr RFS for Arm1/Arm2 was 61%/65%, 5-yr OS was 66%/83%, local recurrence was 3%/4%. Conclusions: The addition of cetuximab to preoperative CRT for LARC was associated with increased but manageable toxicities. pCR rates were similar between treatment arms, as were survival statistics and local recurrence rates. No association was found between KRAS status and pCR. Clinical trial information: NCT00527111. [Table: see text]

scholarly journals Management of Clinically Involved Lateral Lymph Node Metastasis in Locally Advanced Rectal Cancer: A Radiation Dose Escalation Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Xiaolin Pang ◽  
Liang Huang ◽  
Yan Ma ◽  
Zhanzhen Liu ◽  
Peiyi Xie ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Neoadjuvant Chemotherapy ◽  
Response Rate ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Short Axis ◽  
Recurrence Rates

BackgroundPatients with lateral lymph nodes (LLNs) metastasis are not effectively treated with neoadjuvant chemoradiotherapy. This study aimed to compare the efficacy of three neoadjuvant therapeutic regimens, namely, chemotherapy, chemoradiotherapy, and chemoradiotherapy with a dose boost of LLNs, and to identify the optimal approach for treating LLNs metastasis of locally advanced rectal cancer.MethodsA total of 202 patients with baseline LLNs metastasis (short axis ≥5 mm) and treated with neoadjuvant treatment, followed by radical surgery from 2011 to 2019, were enrolled. The short axis of the LLNs on baseline and restaging MRI were recorded. Survival outcomes were compared.ResultsIn the booster subgroup, shrinkage of LLNs was significantly greater than in the neoadjuvant chemotherapy and chemoradiotherapy subgroups (P &lt;0.001), without increasing radiation related side effects (P = 0.121). For patients with baseline LLNs of short axis ≥5 mm in the booster subgroup, the response rate (short axis &lt;5 mm on restaging MRI) was 72.9%, significantly higher than patients in the neoadjuvant chemotherapy subgroup (48.9%, P = 0.007) and higher than for patients in the neoadjuvant chemoradiotherapy group (65.0%), but there was no statistical difference (P = 0.411). The 3-year local recurrence and lateral local recurrence rates were both 2.3% in the dose booster group, which were lower than those of the other two subgroups (local recurrence: P &lt;0.001; lateral local recurrence: P &lt;0.001). The short axis of lateral lymph nodes (≥5 and &lt;5 mm) on restaging MRI was an independent risk factor for prognosis (P &lt;0.05).ConclusionRadiation dose boost is an effective way of increasing the response rate and decreasing recurrence rates. The restaging LLNs with short axis ≥5 mm is a predictor of poor prognosis.

scholarly journals Complete histopathological regression in rectal cancer after neoadjuvant chemoradiotherapy and sphincter preserving surgical treatment

2018 ◽  
Vol 75 (7) ◽  
pp. 698-703
Author(s):  
Tomislav Petrovic ◽  
Slavica Knezevic-Usaj ◽  
Dragana Radovanovic ◽  
Dejan Lukic ◽  
Nemanja Petrovic ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Locally Advanced ◽  
Survival Rates ◽  
Advanced Rectal Cancer ◽  
Preoperative Chemoradiotherapy ◽  
Locally Advanced Rectal Cancer ◽  
Chemoradiation Therapy ◽  
Clinical Staging ◽  
Preoperative Radiation

Background/Aim. Multimodal approach to locally advanced rectal cancer treatment results in better disease outcome. Preoperative chemoradiotherapy improves disease local control, reduces risk of local recurrence and in the majority of patients with complete or substantial regression of the tumors significantly improves survival rates. According to the literature data, approximately 20% of patients had achieved complete histopathological response (pCR) after neoadjuvant chemoradiation therapy. The aim of this study was to evaluate overall survival in rectal cancer patients treated with preoperative chemoradiotherapy and sphincter preserving surgery. Methods. This retrospective study included 191 patients. Patients received preoperative radiation therapy and chemotherapy-chemoradiation therapy (CRT) followed by operation that favorized sphincter preservation with total mesorectal excision (TME) from June 2000 until December 2010. Diagnosis was established according to the following algorithm: patient history, digital rectal examiantion, colonoscopy with biopsy and histopathology verification, and preoperative clinical staging. Patients with tumors located below promontorium were included in the study and patients with metastatic disease and local recurrence were excluded from the study. For tumors located below the promontorium preoperative radiotherapy was used with total dose of 50.4 Gy, divided into daily doses of 1.8 Gy, during 28 days. Chemotherapy followed radiotherapy with 5- fluorouracil and folic acid (Leucovorin?) on days 1, 2, 10, 11, 20 and 21. Six to ten weeks after neoadjuvant therapy, magnetic resonance imaging (MRI) to restage tumors and operation were performed. Results. Of all patients that received preopertive chemoradiation, 163 had radical sphincter preservig surgery and 28 patients had paliative operations. Histopathological examination of the specimens showed that the complete histopathological regression was achieved in 21.4% of the patients, downstaged was found in 63.2% of them and unchanged stage was found in 15.3% of the patients. The five-year survival rate was 63.3% and 50.5 % in the patients with pCR and patients with incomplete histopathological regression, respectively. Survival rates between two groups were not statistically significant (p > 0.05). Conclusion. The preoperative chemoradiotherapy is very important in achieving optimal clinical care for patients with locally advanced rectal cancer.

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