PURPOSE: Neoadjuvant chemoradiation (NCRT) may be avoided in some patients with T3-staged rectal cancer undergoing radical resection. We aimed to evaluate the accuracy of endorectal ultrasound (ERUS) in the nodal staging of uT3 tumors and hence the decision for administration of NCRT. METHODS: Patients with uT3-staged rectal cancer who underwent proctectomy were retrospectively identified. The accuracy of ERUS for detecting nodal involvement was determined for patients who did not undergo NCRT. In order to evaluate the impact of use of NCRT, oncologic outcomes, functional outcomes, and quality of life (QOL) were compared for patients who received NCRT (group A) and those who did not (group B). RESULTS: For 384 patients who were included, ERUS overstaging rate for nodal involvement was 6.3% while understaging rate was 23.2%. For the 289 patients in group A and 95 in group B, Kaplan-Meier analysis showed similar 5-year local recurrence rates (3.5%), overall survival (76.9 vs 75.6%), and disease-free survival (87.9 vs 88.1%). Node positivity on final pathology was however associated with worse 5-year local recurrence (9.3 vs 4.3%). For patients undergoing restorative resection, NCRT was associated with worse functional outcomes but QOL was similar. CONCLUSIONS: ERUS identification of nodal involvement used as a criterion for NCRT carries a greater risk for undertreatment than overtreatment. Undertreatment adversely affects oncologic outcomes. While there is functional impairment related to NCRT, its effect on QOL is non-significant. The decision for omitting neoadjuvant chemoradiation for uT3 rectal cancer should hence not be based on ERUS nodal staging alone.
PURPOSE: Neoadjuvant chemoradiation (NCRT) may be avoided in some patients with T3-staged rectal cancer undergoing radical resection. We aimed to evaluate the accuracy of endorectal ultrasound (ERUS) in the nodal staging of uT3 tumors and hence the decision for administration of NCRT. METHODS:Patients with uT3-staged rectal cancer who underwent proctectomy were retrospectively identified. The accuracy of ERUS for detecting nodal involvement was determined for patients who did not undergo NCRT. In order to evaluate the impact of use of NCRT, oncologic outcomes, functional outcomes, and quality of life (QOL) were compared for patients who received NCRT (group A) and those who did not (group B). RESULTS: For 384 patients who were included, ERUS overstaging rate for nodal involvement was 6.3% while understaging rate was 23.2%. For the 289 patients in group A and 95 in group B, Kaplan-Meier analysis showed similar 5-year local recurrence rates (3.5%), overall survival (76.9 vs 75.6%), and disease-free survival (87.9 vs 88.1%). Node positivity on final pathology was however associated with worse 5-year local recurrence (9.3 vs 4.3%). For patients undergoing restorative resection, NCRT was associated with worse functional outcomes but QOL was similar. CONCLUSIONS: ERUS identification of nodal involvement used as a criterion for NCRT carries a greater risk for undertreatment than overtreatment. Undertreatment adversely affects oncologic outcomes. While there is functional impairment related to NCRT, its effect on QOL is non-significant. The decision for omitting neoadjuvant chemoradiation for uT3 rectal cancer should hence not be based on ERUS nodal staging alone.
Authors: E Kapiteijn; C A Marijnen; I D Nagtegaal; H Putter; W H Steup; T Wiggers; H J Rutten; L Pahlman; B Glimelius; J H van Krieken; J W Leer; C J van de Velde Journal: N Engl J Med Date: 2001-08-30 Impact factor: 91.245
Authors: Paul F Engstrom; Juan Pablo Arnoletti; Al B Benson; Yi-Jen Chen; Michael A Choti; Harry S Cooper; Anne Covey; Raza A Dilawari; Dayna S Early; Peter C Enzinger; Marwan G Fakih; James Fleshman; Charles Fuchs; Jean L Grem; Krystyna Kiel; James A Knol; Lucille A Leong; Edward Lin; Mary F Mulcahy; Sujata Rao; David P Ryan; Leonard Saltz; David Shibata; John M Skibber; Constantinos Sofocleous; James Thomas; Alan P Venook; Christopher Willett Journal: J Natl Compr Canc Netw Date: 2009-09 Impact factor: 11.908
Authors: C A M Marijnen; E Kapiteijn; C J H van de Velde; H Martijn; W H Steup; T Wiggers; E Klein Kranenbarg; J W H Leer Journal: J Clin Oncol Date: 2002-02-01 Impact factor: 44.544
Authors: Karlheinz Ammann; Werner Kirchmayr; Alexander Klaus; Gilbert Mühlmann; Reinhold Kafka; Michael Oberwalder; Alexander De Vries; Dietmar Ofner; Helmut Weiss Journal: Arch Surg Date: 2003-03
Authors: Koen C M J Peeters; Corrie A M Marijnen; Iris D Nagtegaal; Elma Klein Kranenbarg; Hein Putter; Theo Wiggers; Harm Rutten; Lars Pahlman; Bengt Glimelius; Jan Willem Leer; Cornelis J H van de Velde Journal: Ann Surg Date: 2007-11 Impact factor: 12.969
Authors: David Sebag-Montefiore; Richard J Stephens; Robert Steele; John Monson; Robert Grieve; Subhash Khanna; Phil Quirke; Jean Couture; Catherine de Metz; Arthur Sun Myint; Eric Bessell; Gareth Griffiths; Lindsay C Thompson; Mahesh Parmar Journal: Lancet Date: 2009-03-07 Impact factor: 79.321