Mucinous and Non-Mucinous Rectal Adenocarcinoma—Differences in Treatment Response to Preoperative Radiotherapy

There is a need to personalize the treatment for rectal cancer patients. The aim of this study was to analyze therapy response and prognosis after preoperative radiotherapy in rectal cancer patients with mucinous adenocarcinoma compared to those with non-mucinous adenocarcinoma. The study included retrospectively collected data from 433 patients, diagnosed with rectal cancer in the South East health care region in Sweden between 2004 and 2012. Patients with non-mucinous adenocarcinoma that received short-course radiotherapy before surgery had better overall survival, cancer specific survival, and disease-free survival, as well as distant- and local-recurrence-free survival (p = 0.003, p = 0.001, p = 0.002, p = 0.002, and p = 0.033, respectively) compared to the patients that received long-course radiotherapy with concomitant capecitabine. The results were still significant after adjusting for sex, age, stage, differentiation, and chemotherapy in the neoadjuvant and/or adjuvant setting, except for local-recurrence-free survival that was trending towards significance (p = 0.070). In patients with mucinous adenocarcinoma, no difference in survival was seen when comparing patients that had short-course radiotherapy and patients that had long-course radiotherapy. However, none of 18 patients with mucinous adenocarcinoma treated with long-course radiotherapy had local tumor progression, compared to 7% of 67 patients with non-mucinous adenocarcinoma. The results indicate that mucinous adenocarcinoma and non-mucinous adenocarcinoma may respond differently to radiotherapy.

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164 Preoperative radiation with concurrent chemotherapy for respectable rectal cancer: Does dose escalation improve local recurrence free survival and disease free survival?

Radiotherapy and Oncology ◽

10.1016/s0167-8140(04)80664-9 ◽

2004 ◽

Vol 72 ◽

pp. S50

Keyword(s):

Rectal Cancer ◽

Local Recurrence ◽

Dose Escalation ◽

Disease Free Survival ◽

Concurrent Chemotherapy ◽

Preoperative Radiation ◽

Recurrence Free Survival ◽

Free Survival ◽

Local Recurrence Free Survival ◽

Disease Free

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A randomized trial comparing local recurrence (LR) rates between short-course (SC) and long-course (LC) preoperative radiotherapy (RT) for clinical T3 rectal cancer: An intergroup trial (TROG, AGITG, CSSANZ, RACS).

Journal of Clinical Oncology ◽

10.1200/jco.2010.28.15_suppl.3509 ◽

2010 ◽

Vol 28 (15_suppl) ◽

pp. 3509-3509 ◽

Cited By ~ 31

Author(s):

S. Ngan ◽

R. Fisher ◽

D. Goldstein ◽

M. Solomon ◽

B. Burmeister ◽

...

Keyword(s):

Rectal Cancer ◽

Local Recurrence ◽

Randomized Trial ◽

Preoperative Radiotherapy ◽

Short Course ◽

T3 Rectal Cancer ◽

Intergroup Trial ◽

Long Course

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Acceptance of sphincter-preserving surgery for T3 lower rectal cancer after short-course radiotherapy with delayed surgery.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.3_suppl.620 ◽

2014 ◽

Vol 32 (3_suppl) ◽

pp. 620-620

Author(s):

Naohito Beppu ◽

Hidenori Yanagi ◽

Naoki Yamanaka ◽

Hiroshi Doi ◽

Norihiko Kamikonya ◽

...

Keyword(s):

Rectal Cancer ◽

Lower Rectal Cancer ◽

Distal Margin ◽

Recurrence Free Survival ◽

Long Term Outcomes ◽

Free Survival ◽

Delayed Surgery ◽

Short Course ◽

Short Course Radiotherapy

620 Background: One of the reasons for avoiding sphincter-preserving surgery for lower rectal cancer is difficulty in obtaining a sufficient distal margin. Short-course radiotherapy (SRT) with immediate surgery is not expected to reduce tumor volume, and currently available evidence suggests that it does not increase the sphincter-preservation rate. However, SRT with delayed surgery has been linked to downsizing of the primary tumor during the waiting period. We evaluated the feasibility of sphincter-preserving surgery for T3 lower rectal cancer after SRT with delayed surgery and examined whether a distal margin of ≤ 5 mm has an impact on oncologic outcomes. Methods: We retrospectively studied 161 consecutive patients with lower rectal cancer located below the peritoneum reflection who underwent radical surgery with total mesorectum resection (TME) 3 to 4 weeks after the completion of SRT. The median follow-up was 53.5 months. Results: Sphincter-preserving surgery was performed in 149 (92.5%) of the 161 patients. The procedures were as follows: double-stapling technique, 58 patients; intersphincteric resection, 91; abdominoperineal resection, 10; and Hartmann operation, 2. Among the patients who underwent sphincter-preserving surgery, the distal margin was ≤ 5 mm in 41 patients and > 5 mm in 108. The local recurrence rate was respectively 5.8% vs. 10.4% (p = 0.606), the recurrence-free survival 83.4% vs. 82.8% (p = 0.682), and the overall survival at 5 years 82.3% vs. 87.6% (p = 0.418). Our results suggested that there is no difference in long-term outcomes between a distal margin of ≤ 5 mm and > 5 mm. Conclusions: Sphincter-preserving surgery was performed in 92.5% of patients with T3 lower rectal cancer who received SRT with delayed surgery. Our results confirmed the long-term oncologic feasibility of sphincter-preserving surgery with a distal margin of ≤ 5 mm; there was no negative impact on long-term outcomes such as local recurrence, recurrence-free survival, and overall survival.

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