Effect of Adjuvant Radiotherapy on Local Recurrence in Stage II Rectal Cancer

2007 ◽  
Vol 15 (2) ◽  
pp. 519-525 ◽  
Author(s):  
In Ja Park ◽  
Hee Cheol Kim ◽  
Chang Sik Yu ◽  
Tae Won Kim ◽  
Se Jin Jang ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Adjuvant Radiotherapy ◽  
Stage Ii

scholarly journals Postoperative XELOX therapy for patients with curatively resected high-risk stage II and stage III rectal cancer without preoperative chemoradiation: a prospective, multicenter, open-label, single-arm phase II study

BMC Cancer ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Tsunekazu Mizushima ◽  
Masataka Ikeda ◽  
Takeshi Kato ◽  
Atsuyo Ikeda ◽  
Junichi Nishimura ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
High Risk ◽  
Local Recurrence ◽  
Phase Ii ◽  
Group Performance ◽  
Phase Ii Study ◽  
Preoperative Chemoradiation ◽  
Stage Ii ◽  
Stage Iii ◽  
Open Label

Abstract Background Preoperative 5-FU-based chemoradiation is currently a standard treatment for advanced rectal cancer, particularly in Western countries. Although it reduced the local recurrence, it could not necessarily improve overall survival. Furthermore, it can also produce adverse effects and long-term sphincter function deficiency. Adjuvant oxaliplatin plus capecitabine (XELOX) is a recommended regimen for patients with curatively resected colon cancer. However, the efficacy of postoperative adjuvant therapy for rectal cancer patients who have not undergone preoperative chemoradiation remains unknown. We aimed to evaluate the efficacy of surgery and postoperative XELOX without preoperative chemoradiation for treating rectal cancer. Methods We performed a prospective, multicenter, open-label, single arm phase II study. Patients with curatively resected high-risk stage II and stage III rectal cancer who had not undergone preoperative therapy were treated with a 120 min intravenous infusion of oxaliplatin (130 mg/m2) on day 1 and capecitabine (2000 mg/m2/day) in 2 divided doses for 14 days of a 3-week cycle, for a total of 8 cycles (24 weeks). The primary endpoint was 3-year disease-free survival (DFS). Results Between August 2012 and June 2015, 60 men and 47 women with a median age was 63 years (range: 29–77 years) were enrolled. Ninety-three patients had Eastern Cooperative Oncology Group performance status scores of ‘0’ and 14 had scores of ‘1’. Tumors were located in the upper and lower rectums in 54 and 48 patients, respectively; 8 patients had stage II disease and 99 had stage III. The 3-year DFS was 70.1% (95% confidence interval, 60.8–78.0%) and 33 patients (31%) experienced recurrence, most commonly in the lung (16 patients) followed by local recurrence (9) and hepatic recurrence (7). Conclusions Postoperative XELOX without preoperative chemoradiation is effective for rectal cancer and provides adequate 3-year DFS prospects. Trial registration This clinical trial was registered in the University Hospital Medical Information Network registry system as UMIN000008634 at Aug 06, 2012.

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

2008 ◽  
Vol 23 (11) ◽  
pp. 1073-1079 ◽  
Author(s):  
Shin Fujita ◽  
Seiichiro Yamamoto ◽  
Takayuki Akasu ◽  
Yoshihiro Moriya
Keyword(s):  
Rectal Cancer ◽  
Adjuvant Radiotherapy ◽  
Clinical Stage ◽  
Stage Ii

Pushing the envelope beyond a centimeter in rectal cancer: Oncologic implications of close but negative margins.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 487-487
Author(s):  
T. L. Fitzgerald ◽  
J. Brinkley ◽  
E. E. Zervos
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Adjuvant Therapy ◽  
Adjuvant Radiotherapy ◽  
Meta Analysis ◽  
Sphincter Preservation ◽  
Distal Margin ◽  
Recurrence Rates ◽  
Randomized Controlled Studies ◽  
Number Of Patients

487 Background: Advances in surgery, adjuvant therapy and understanding of the natural history of rectal cancer has enabled sphincter preservation surgery for most patients. A 1 cm margin is commonly accepted as minimal distal margin, when not achievable many are relegated to permanent colostomy. Our purpose was to determine if distal margins of < 1 cm is justified by the world's published experience. Methods: Studies were identified with a MEDLINE search using terms rectal cancer, colorectal cancer, margins and distal margins with an additional manual search. There were no restrictions on data type or year of publication. All studies were retrospective or prospective, none were randomized controlled. Studies were excluded if specific margins, local recurrence rates or case level data could not be extracted. Extracted variables included year of publication, time span, number of patients, standardized surgery, radiotherapy, margins, follow up, local recurrence rates and overall survival. Meta-analysis was performed using a random weighting scheme. Values were aggregated across studies to determine overall impact and p-values. Results: Seventeen studies reported margins with thirteen studies, 3,232 patients, reporting outcomes when < 1cm. Meta-analysis of all studies indicated a nonsignificant trend favoring greater margins. However, in order to understand distal margins in the context of current standards additional analyses were performed. Of the thirteen studies 4 reported neither TME nor use adjuvant radiotherapy and 9 studies reported use of one or both. When either total mesorectal excision and/or adjuvant radiotherapy was reported there was no significant increase in local recurrence with distal margins < 1 cm. In studies that used neither therapy > 1 cm margins were statistically less prone to recurrence. Conclusions: Sphincter preservation is possible with < 1 cm distal margin when optimal surgical and adjuvant therapy are applied. [Table: see text]

scholarly journals Which Definition of Upper Rectal Cancer Is Optimal in Selecting Stage II or III Rectal Cancer Patients to Avoid Postoperative Adjuvant Radiation?

2021 ◽  
Vol 10 ◽  
Author(s):  
Xian Hua Gao ◽  
Bai Zhi Zhai ◽  
Juan Li ◽  
Jean Luc Tshibangu Kabemba ◽  
Hai Feng Gong ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Cancer Patients ◽  
Anal Verge ◽  
Body Height ◽  
Tumor Location ◽  
Stage Ii ◽  
Adjuvant Radiation ◽  
Significant Difference ◽  
Definition Of

BackgroundIn most guidelines, upper rectal cancers (URC) are not recommended to take neoadjuvant or adjuvant radiation. However, the definitions of URC vary greatly. Five definitions had been commonly used to define URC: 1) &gt;10 cm from the anal verge by MRI; 2) &gt;12 cm from the anal verge by MRI; 3) &gt;10 cm from the anal verge by colonoscopy; 4) &gt;12 cm from the anal verge by colonoscopy; 5) above the anterior peritoneal reflection (APR). We hypothesized that the fifth definition is optimal to identify patients with rectal cancer to avoid adjuvant radiation.MethodsThe data of stage II/III rectal cancer patients who underwent radical surgery without preoperative chemoradiotherapy were retrospectively reviewed. The height of the APR was measured, and compared with the tumor height measured by digital rectal examination (DRE), MRI and colonoscopy. The five definitions were compared in terms of prediction of local recurrence, survival, and percentages of patients requiring radiation.ResultsA total of 576 patients were included, with the intraoperative location of 222 and 354 tumors being above and straddle/below the APR, respectively. The median distance of the APR from anal verge (height of APR) as measured by MRI was 8.7 (range: 4.5–14.3) cm. The height of APR positively correlated with body height (r=0.862, P&lt;0.001). The accuracy of the MRI in determining the tumor location with respect to the APR was 92.1%. Rectal cancer above the APR had a significantly lower incidence of local recurrence than those straddle/below the APR (P=0.042). For those above the APR, there was no significant difference in local recurrence between the radiation and no-radiation group. Multivariate analyses showed that tumor location regarding APR was an independent risk factor for LRFS. Tumor height as measured by DRE, MRI and colonoscopy were not related with survival outcomes. Fewer rectal cancer patients required adjuvant radiation using the definition by the APR, compared with other four definitions based on a numerical tumor height measured by MRI and colonoscopy.ConclusionsThe definition of URC as rectal tumor above the APR, might be the optimal definition to select patients with stage II/III rectal cancer to avoid postoperative adjuvant radiation.

scholarly journals Local recurrence after five years is associated with preoperative chemoradiotherapy treatment in patients diagnosed with stage II and III rectal cancer

2017 ◽  
Vol 44 ◽  
pp. 15-20 ◽  
Author(s):  
Gabriel Marin ◽  
Javier Suárez ◽  
Ruth Vera ◽  
Enrique Balén ◽  
Antonio Viudez ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Preoperative Chemoradiotherapy ◽  
Stage Ii

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

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e15008-e15008 ◽  
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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