Guilherme Pagin São Julião1, Angelita Habr-Gama1, Bruna Borba Vailati1, Patricia Bailão Aguilar2, Jorge Sabbaga3, Sérgio Eduardo Alonso Araújo4, Adrian Mattacheo1, Flavia Andrea Alexandre1, Laura Melina Fernandez1, Diogo Bugano Gomes5, Joaquim Gama-Rodrigues1, Rodrigo Oliva Perez6. 1. Angelita & Joaquim Gama Institute, Rua Manoel da Nobrega, 1564, Sao Paulo, SP, 04001-005, Brazil. 2. Hospital Alemão Oswaldo Cruz - Radiation Oncology, Rua Joao Juliao, 331, Sao Paulo, SP, 01323-020, Brazil. 3. Centro de Oncologia Molecular - Hospital Sirio-Libanês, Rua Dona Adma Jafet, 91, Sao Paulo, SP, 01308-050, Brazil. 4. University of São Paulo School of Medicine, Colorectal Surgery Division, Av. Dr. Arnaldo, 455, Sao Paulo, SP, 01246-903, Brazil; Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sao Paulo, SP, 05652-900, Brazil. 5. Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sao Paulo, SP, 05652-900, Brazil. 6. Angelita & Joaquim Gama Institute, Rua Manoel da Nobrega, 1564, Sao Paulo, SP, 04001-005, Brazil; University of São Paulo School of Medicine, Colorectal Surgery Division, Av. Dr. Arnaldo, 455, Sao Paulo, SP, 01246-903, Brazil; Ludwig Institute for Cancer Research São Paulo Branch, Rua Dona Adma Jafet, 91, Sao Paulo, SP, 01308-050, Brazil. Electronic address: rodrigo.operez@gmail.com.
Abstract
Patients with cT3 rectal cancer are less likely to develop complete response to neoadjuvant chemoradiation (nCRT) and still face significant risk for systemic relapse. In this setting, radiation (RT) dose-escalation and consolidation chemotherapy in "extended" nCRT regimens have been suggested to improve primary tumor response and decrease the risks of systemic recurrences. For these reasons we compared surgery-free and distant-metastases free survival among cT3 patients undergoing standard or extended nCRT. METHODS: Patients with distal and non-metastatic T3 rectal cancer managed by nCRT were retrospectively reviewed. Patients undergoing standard CRT (50.4 Gy and 2 cycles of 5FU-based chemotherapy) were compared to those undergoing extended CRT (54 Gy and 6 cycles of 5FU-based chemotherapy). Patients were assessed for tumor response at 8-10 weeks. Patients with complete clinical response (cCR) underwent organ-preservation strategy (Watch & Wait). Patients were referred to salvage surgery in the event of local recurrence during follow-up. Cox's logistic regression was performed to identify independent features associated with improved surgery-free survival after cCR and distant-metastases-free survival. RESULTS: 155 patients underwent standard and 66 patients extended CRT. Patients undergoing extended CRT were more likely to harbor larger initial tumor size (p = 0.04), baseline nodal metastases (cN+; p < 0.001) and higher tumor location (p = 0.02). Cox-regression analysis revealed that the type of nCRT regimen was not independently associated with distinct surgery-free survival after cCR or distant-metastases-free survival (p > 0.05). CONCLUSIONS: Dose-escalation and consolidation chemotherapy are insufficient to increase long-term surgery-free survival among cT3 rectal cancer patients and provides no advantage in distant metastases-free survival.
Patients with cT3 rectal cancer are less likely to develop complete response to neoadjuvant chemoradiation (nCRT) and still face significant risk for systemic relapse. In this setting, radiation (RT) dose-escalation and consolidation chemotherapy in "extended" nCRT regimens have been suggested to improve primary tumor response and decrease the risks of systemic recurrences. For these reasons we compared surgery-free and distant-metastases free survival among cT3patients undergoing standard or extended nCRT. METHODS:Patients with distal and non-metastatic T3 rectal cancer managed by nCRT were retrospectively reviewed. Patients undergoing standard CRT (50.4 Gy and 2 cycles of 5FU-based chemotherapy) were compared to those undergoing extended CRT (54 Gy and 6 cycles of 5FU-based chemotherapy). Patients were assessed for tumor response at 8-10 weeks. Patients with complete clinical response (cCR) underwent organ-preservation strategy (Watch & Wait). Patients were referred to salvage surgery in the event of local recurrence during follow-up. Cox's logistic regression was performed to identify independent features associated with improved surgery-free survival after cCR and distant-metastases-free survival. RESULTS: 155 patients underwent standard and 66 patients extended CRT. Patients undergoing extended CRT were more likely to harbor larger initial tumor size (p = 0.04), baseline nodal metastases (cN+; p < 0.001) and higher tumor location (p = 0.02). Cox-regression analysis revealed that the type of nCRT regimen was not independently associated with distinct surgery-free survival after cCR or distant-metastases-free survival (p > 0.05). CONCLUSIONS: Dose-escalation and consolidation chemotherapy are insufficient to increase long-term surgery-free survival among cT3 rectal cancerpatients and provides no advantage in distant metastases-free survival.
Authors: Michael R Marco; Lihong Zhou; Sujata Patil; Jorge E Marcet; Madhulika G Varma; Samuel Oommen; Peter A Cataldo; Steven R Hunt; Anjali Kumar; Daniel O Herzig; Alessandro Fichera; Blase N Polite; Neil H Hyman; Charles A Ternent; Michael J Stamos; Alessio Pigazzi; David Dietz; Yuliya Yakunina; Raphael Pelossof; Julio Garcia-Aguilar Journal: Dis Colon Rectum Date: 2018-10 Impact factor: 4.585
Authors: Seong Ho Park; Seung Hyun Cho; Sang Hyun Choi; Jong Keon Jang; Min Ju Kim; Seung Ho Kim; Joon Seok Lim; Sung Kyoung Moon; Ji Hoon Park; Nieun Seo Journal: Korean J Radiol Date: 2020-07 Impact factor: 3.500