Local recurrence after surgery for locally advanced rectal cancer treated with or without preoperative chemoradiotherapy
Abstract
Introduction: The ²gold standard² for patients with locally advanced rectal cancer is neoadjuvant chemoradiotherapy followed by surgery.
Aim: Evaluation of local recurrence after surgery for locally advanced rectal cancer.
Methods and patients: Retrospective study included 189 patients, who were operated at Oncology Institute of Vojvodina from January 1st 2012 until December 31st 2017. Patients were divided into two groups. In the first group 73 patients who received chemoradiotherapy were included, while 116 patients without neoadjuvant treatment were in the second group. All patients were diagnosed with locally advanced rectal cancer. The existence of operable metastases in the liver and/or lungs did not exclude patients from the study. Patients who had undergone resection of the rectum by Miles, Hartmann or local tumor excision were excluded from the study.
Results: The median follow-up period was 48 months (range 13-84). In total, 23 (12.2%) patients developed local recurrence. In the chemoradiotherapy group, 15.1% (11 of 73 patients) had a local recurrence, as compared with 10.3% (12 of 116 patients) in the group without neoadjuvant treatment. In both groups, there were no correlation between rate of local recurrence with other clinical and pathological parameters such as gender, tumor location, T and N stage, histological differentiation, or lymphovascular and perineural invasion (p>0.05). We confirmed significant association between circumferential resection margin with local recurrence in patients who were treated by preoperative chemoradiation (p=0.014).
Conclusion: This study has not shown reduced risk of local recurrence after neoadjuvant therapy most likely due to small number of patients. Despite our results, neoadjuvant treatment followed by surgery remains the best treatment protocol for patients with locally advanced rectal cancer.
References
Roh MS, Colangelo LH, O'Connell MJ, Yothers G, Deutsch M, Allegra CJ, Wolmark N. Preoperative Multimodality Therapy Improves Disease-Free Survival in Patients With Carcinoma of the Rectum: NSABP R-03. Journal of Clinical Oncology 2009;27(31):5124-5130. doi: 10.1200/jco.2009.22.0467
Wells BJ, Stotland P, Ko MA, Al-Sukhni W, Wunder J, Ferguson P, Swallow CJ. Results of an Aggressive Approach to Resection of Locally Recurrent Rectal Cancer. Annals of Surgical Oncology 2007;14(2):390-395. doi: 10.1245/s10434-006-9119-4
Hav M, Libbrecht L, Ferdinande L, Geboes K, Pattyn P, Cuvelier CA. Pathologic Assessment of Rectal Carcinoma after Neoadjuvant Radio(chemo)therapy: Prognostic Implications. BioMed Research International 2015:1-11. doi: 10.1155/2015/574540
Dieguez A. Rectal cancer staging: focus on the prognostic significance of the findings described by high-resolution magnetic resonance imaging. Cancer Imaging 2013;13(2):277-297. doi: 10.1102/1470-7330.2013.0028
Li Y, Wang J, Ma X, Tan L, Yan Y, Xue C, Ren J. A Review of Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer. International Journal of Biological Sciences 2016;12(8):1022-1031. doi: 10.7150/ijbs.15438
Dayde D, Tanaka I, Jain R, Tai M, Taguchi A. Predictive and Prognostic Molecular Biomarkers for Response to Neoadjuvant Chemoradiation in Rectal Cancer. International Journal of Molecular Sciences 2017;18(3):573. doi: 10.3390/ijms18030573
Chabowski M, Nowak A, Grzegrzółka J, Piotrowska A, Janczak D, Dzięgiel P. Comparison of Microvessel Density Using Nestin and CD34 in Colorectal Cancer. Anticancer Research 2018;38(7):3889-3895. doi: 10.21873/anticanres.12673
Yun HR, Lee LJ, Park JH, Cho YK, Cho YB, Lee WY, Yun SH. Local recurrence after curative resection in patients with colon and rectal cancers. International Journal of Colorectal Disease 2008;23(11):1081-1087. doi: 10.1007/s00384-008-0530-0
Petrović T, Brebrina M, Radovanović Z, et al. The results of the surgical treatment of rectal cancer. Arch Oncol 2010;18: 3-7.
Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, Raab R. Preoperative versus Postoperative Chemoradiotherapy for Rectal Cancer. New England Journal of Medicine 2004;351(17):1731-1740. doi: 10.1056/nejmoa040694
van Gijn W, Marijnen CA, Nagtegaal ID, Kranenbarg EM, Putter H, Wiggers T, van de Velde CJ. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. The Lancet Oncology 2011;12(6):575-582. doi: 10.1016/s1470-2045(11)70097-3
Gérard J, Conroy T, Bonnetain F, Bouché O, Chapet O, Closon-Dejardin M, Mackiewicz R. Preoperative Radiotherapy With or Without Concurrent Fluorouracil and Leucovorin in T3-4 Rectal Cancers: Results of FFCD 9203. Journal of Clinical Oncology 2006;24(28):4620-4625. doi: 10.1200/jco.2006.06.7629
Bosset J, Collette L, Calais G, Mineur L, Maingon P, Radosevic-Jelic L, Ollier J. Chemotherapy with Preoperative Radiotherapy in Rectal Cancer. New England Journal of Medicine 2006;355(11):1114-1123. doi: 10.1056/nejmoa060829
Nikberg M, Chabok A, Letocha H, Kindler C, Glimelius B, Smedh K. Lymphovascular and perineural invasion in stage II rectal cancer: A report from the Swedish colorectal cancer registry. ActaOncologica 2016;55(12):1418-1424. doi: 10.1080/0284186x.2016.1230274
Kim CH, Yeom S, Lee SY, Kim HR, Kim YJ, Lee KH, Lee JH. Prognostic Impact of Perineural Invasion in Rectal Cancer After Neoadjuvant Chemoradiotherapy. World Journal of Surgery 2019;43(1):260-272. doi: 10.1007/s00268-018-4774-8
Cienfuegos JA, Rotellar F, Baixauli J, Beorlegui C, Sola JJ, Arbea L, Hernández-Lizoáin JL. Impact of Perineural and Lymphovascular Invasion on Oncological Outcomes in Rectal Cancer Treated with Neoadjuvant Chemoradiotherapy and Surgery. Annals of Surgical Oncology 2015;22(3):916-923. doi: 10.1245/s10434-014-4051-5
Jin C, Deng X, Li Y, He W, Yang X, Liu J. Lymph node ratio is an independent prognostic factor for rectal cancer after neoadjuvant therapy: A meta-analysis. Journal of Evidence-Based Medicine 2018;11(3):169-175. doi: 10.1111/jebm.12289
Peng J, Xu Y, Guan Z, Zhu J, Wang M, Cai G, Cai S. Prognostic Significance of the Metastatic Lymph Node Ratio in Node-Positive Rectal Cancer. Annals of Surgical Oncology 2008;15(11):3118-3123. doi: 10.1245/s10434-008-0123-8
Huh JW, Kim YJ, Kim HR. Ratio of Metastatic to Resected Lymph Nodes as a Prognostic Factor in Node-Positive Colorectal Cancer. Annals of Surgical Oncology 2010;17(10):2640-2646. doi: 10.1245/s10434-010-1015-2
Park BK, Lee SJ, Hur BY, Kim MJ, Chan PS, Chang HJ, Oh JH. Feasibility of Selective Lateral Node Dissection Based on Magnetic Resonance Imaging in Rectal Cancer After Preoperative Chemoradiotherapy. Journal of Surgical Research 2018;232:227-233. doi: 10.1016/j.jss.2018.05.047
Wheeler JMD, Dodds E, Warren BF, Cunningham C, George BD, Jones AC, Mortensen NJM. Preoperative Chemoradiotherapy and Total Mesorectal Excision Surgery for Locally Advanced Rectal Cancer: Correlation With Rectal Cancer Regression Grade. Diseases of the Colon and Rectum 2004;47(12):2025-2031. doi: 10.1007/s10350-004-0713-x
Quirke P, Steele R, Monson J, Grieve R, Khanna S, Couture J, Sebag-Montefiore D. Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: A prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. The Lancet 2009;373(9666):821-828. doi: 10.1016/s0140-6736(09)60485-2
Habr-Gama A, Perez RO, Nadalin W, Sabbaga J, Ribeiro U, Silva eAH, Gama-Rodrigues J. Operative Versus Nonoperative Treatment for Stage 0 Distal Rectal Cancer Following Chemoradiation Therapy. Transactions of the ... Meeting of the American Surgical Association 2004;CXXII:309-316. doi: 10.1097/01.sla.0000141194.27992.32
García-Aguilar J, Hernandez dE, Sirivongs P, Lee S, Madoff RD, Rothenberger DA. A Pathologic Complete Response to Preoperative Chemoradiation Is Associated With Lower Local Recurrence and Improved Survival in Rectal Cancer Patients Treated by Mesorectal Excision. Diseases of the Colon and Rectum 2003;46(3):298-304. doi: 10.1007/s10350-004-6545-x
Petrovic T, Radovanovic Z, Bokorov B, Nikolic I, Knezevic-Usaj S, Cankovic M. Analysis of patients with complete histopathological tumour regression after neoadjuvant chemoradiotherapy for locally advanced rectal cancer. Archive of oncology 2010;18(1-2):3-7. doi: 10.2298/aoo1002003p
Maas M, Nelemans PJ, Valentini V, Das P, Rödel C, Kuo L, Suárez J. Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data. The Lancet Oncology 2010;11(9):835-844. doi: 10.1016/s1470-2045(10)70172-8
