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International Journal of Colorectal Disease

, Volume 34, Issue 12, pp 2161–2169 | Cite as

Neoadjuvant chemo-radiotherapy for cT3N0 rectal cancer: any benefit over upfront surgery? A propensity score-matched study

  • Luca Sorrentino
  • Marcello GuaglioEmail author
  • Luigi Battaglia
  • Giuliano Bonfanti
  • Marco Vitellaro
  • Alessandro Cesa Bianchi
  • Massimo Milione
  • Filiberto BelliEmail author
Original Article

Abstract

Purpose

Benefits of neoadjuvant chemo-radiotherapy (CRT) are well known for locally advanced and/or node-positive rectal cancer, but the best timing for CRT has been less explored for cT3N0 patients. The aim of the present study was to compare the 5-year disease-free survival (DFS) probability between neoadjuvant CRT and upfront surgery in patients affected by cT3N0 rectal cancer.

Methods

A retrospective review of 105 patients affected by cT3N0 rectal cancer, staged by pelvic magnetic resonance imaging and treated at the National Cancer Institute of Milan between 2011 and 2017, was performed: 42 (40.0%) were treated by neoadjuvant CRT and 63 (60.0%) by upfront surgery. Propensity score matching was performed to avoid selection bias, and Cox multivariate regression was used to analyze outcomes.

Results

The 5-year DFS probability was 87.5% in neoadjuvant CRT patients vs. 90.0% in upfront surgery cases (Log-rank p = 0.76). The 5-year loco-regional recurrence-free survival probability was respectively 96.8% vs. 96.3% (Log-rank p = 0.954). On multivariate analysis, neoadjuvant CRT had no impact on DFS when compared to upfront surgery (adjusted HR 0.71, 95%CI 0.18–2.70, p = 0.613), but 61.9% of upfront surgery cases were treated by adjuvant chemo-radiation (adjusted HR 0.41, 95%CI 0.11–1.57, p = 0.196). The only independent predictor of improved DFS was age at diagnosis (adjusted HR 0.95, p = 0.017).

Conclusion

CRT should be considered for cT3N0 patients, but its timing (neoadjuvant vs. adjuvant) seems not to affect the disease-free survival in the present cohort of patients.

Keywords

Rectal cancer T3N0 Neoadjuvant chemo-radiation therapy Surgery Adjuvant radiotherapy 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

384_2019_3446_MOESM1_ESM.docx (63 kb)
ESM 1 (DOCX 63 kb)

References

  1. 1.
    Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351(17):1731–1740CrossRefGoogle Scholar
  2. 2.
    Zorcolo L, Rosman AS, Restivo A, Pisano M, Nigri GR, Fancellu A, Melis M (2012) Complete pathologic response after combined modality treatment for rectal cancer and long-term survival: a meta-analysis. Ann Surg Oncol 19(9):2822–2832CrossRefGoogle Scholar
  3. 3.
    Glynne-Jones R, Wyrwicz L, Tiret E et al (2017) Rectal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 28(4):22–40CrossRefGoogle Scholar
  4. 4.
    Kim JS, Kim NK, Min BS et al (2010) Adjuvant radiotherapy following total mesorectal excision for stage IIA rectal cancer: is it beneficial? Int J Color Dis 25(9):1103–1110CrossRefGoogle Scholar
  5. 5.
    Holm T, Singnomklao T, Rutqvist LE, Cedermark B (1996) Adjuvant preoperative radiotherapy in patients with rectal carcinoma. Adverse effects during long term follow-up of two randomized trials. Cancer 78(5):968–976CrossRefGoogle Scholar
  6. 6.
    Sebag-Montefiore D, Stephens RJ, Steele R et al (2009) Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet 373(9666):811–820CrossRefGoogle Scholar
  7. 7.
    Peeters KC, Marijnen CA, Nagtegaal ID et al (2007) The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg 246(5):693–701CrossRefGoogle Scholar
  8. 8.
    Eriksen MT, Wibe A, Haffner J, Wiig JN, Norwegian Rectal Cancer Group (2007) Prognostic groups in 1,676 patients with T3 rectal cancer treated without preoperative radiotherapy. Dis Colon Rectum 50(2):156–167CrossRefGoogle Scholar
  9. 9.
    Park JS, Jang Y-J, Choi GS et al (2014) Accuracy of preoperative MRI in predicting pathology stage in rectal cancers: node-for-node matched histopathology validation of MRI features. Dis Col Rectum 57:32–38CrossRefGoogle Scholar
  10. 10.
    Suppiah A, Hunter IA, Cowley J et al (2009) Magnetic resonance imaging accuracy in assessing tumour down-staging following chemo-radiation in rectal cancer. Color Dis 11:249–253CrossRefGoogle Scholar
  11. 11.
    Srisajjakul S, Prapaisilp P, Bangchokdee S (2018) Pitfalls in MRI of rectal cancer: what radiologists need to know and avoid. Clin Imaging 50:130–140CrossRefGoogle Scholar
  12. 12.
    Sun W, Dou R, Chen J et al (2019) Impact of long-course neoadjuvant radiation on postoperative low anterior resection syndrome and quality of life in rectal cancer: post hoc analysis of a randomized controlled trial. Ann Surg Oncol 26(3):746–755CrossRefGoogle Scholar
  13. 13.
    Marijnen CA, Kapiteijn E, van de Velde CJ et al (2002) Acute side effects and complications after short-term preoperative radiotherapy combined with total mesorectal excision in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol 20(3):817–825CrossRefGoogle Scholar
  14. 14.
    van Gijn W, Marijnen CA, Nagtegaal ID et al (2011) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol 12(6):575–582CrossRefGoogle Scholar
  15. 15.
    Roh MS, Colangelo LH, O’Connell MJ et al (2009) Preoperative multimodality therapy improves disease-free survival in patients with carcinoma of the rectum: NSABP R-03. J Clin Oncol 27:5124–5130CrossRefGoogle Scholar
  16. 16.
    Park J, Neuman HB, Weiser MR, Wong WD (2010) Randomized clinical trials in rectal and anal cancers. Surg Oncol Clin N Am 19(1):205–223CrossRefGoogle Scholar
  17. 17.
    Folkesson J, Birgisson H, Pahlman L, Cedermark B, Glimelius B, Gunnarsson U (2005) Swedish Rectal Cancer Trial: long-lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol 23:5644–5650CrossRefGoogle Scholar
  18. 18.
    Ludmir EB, Palta M, Willett CG, Czito BG (2017) Total neoadjuvant therapy for rectal cancer: an emerging option. Cancer 123(9):1497–1506CrossRefGoogle Scholar
  19. 19.
    Peng LC, Milsom J, Garrett K et al (2014) Surveillance, epidemiology, and end results-based analysis of the impact of preoperative or postoperative radiotherapy on survival outcomes for T3N0 rectal cancer. Cancer Epidemiol 38(1):73–78CrossRefGoogle Scholar
  20. 20.
    Kennecke H, Lim H, Woods R et al (2012) Outcomes of unselected patients with pathologic T3N0 rectal cancer. Radiother Oncol 105(2):214–219CrossRefGoogle Scholar
  21. 21.
    Stevenson ARL, Solomon MJ, Brown CSB, Lumley JW, Hewett P, Clouston AD, Gebski VJ, Wilson K, Hague W, Simes J, Australasian Gastro-Intestinal Trials Group (AGITG) ALaCaRT investigators (2019) Disease-free survival and local recurrence after laparoscopic-assisted resection or open resection for rectal cancer: the Australasian Laparoscopic Cancer of the Rectum Randomized Clinical Trial. Ann Surg 269(4):596–602CrossRefGoogle Scholar
  22. 22.
    Fleshman J, Branda ME, Sargent DJ et al (2019) Disease-free survival and local recurrence for laparoscopic resection compared with open resection of stage II to III rectal cancer: follow-up results of the ACOSOG Z6051 randomized controlled trial. Ann Surg 269(4):589–595CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Colorectal Surgery UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
  2. 2.Pathology UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly

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