Acute Adverse Events and Postoperative Complications in a Randomized Trial of Preoperative Short-course Radiotherapy Versus Long-course Chemoradiotherapy for T3 Adenocarcinoma of the Rectum

Ansari, Nabila; Solomon, Michael J.; Fisher, Richard; Mackay, John; Burmeister, Bryan; Ackland, Stephen P.; Heriot, Alexander G.; Joseph, David; McLachlan, Sue Anne; McClure, Bev; Ngan, Samuel Y

doi:10.1097/sla.0000000000001987

Cited by 86 publications

(59 citation statements)

References 16 publications

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“…Grade 3-4 RT induced toxicity must not be compared with surgical site infections or easily treated urinary tract infections. The Australian trial comparing SRT and CRT found no difference between the treatment groups regarding post-operative complications (53.2 % in SRT vs. 50.4% in CRT) 143 . In our material the post-operative complication rate was 50 % in SRT, 38 % in SRT-delay and 39 % in LRT-delay.…”

Section: Complications and Toxicitymentioning

confidence: 96%

“…Both the trials concluded that SRT with immediate surgery are not significantly different from CRT with respect of DFS, OS or rate of LR, but with more acute adverse events in the CRT group. [141][142][143] The optimal time interval within the first week is however debated. In a subgroup analysis from the Dutch TME-trial elderly patients (>75 years) were found to have worse survival if operated on 4-7 days after last RT, compared to having surgery performed 0-3 days after RT.…”

Section: Radiotherapymentioning

confidence: 99%

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Tumour regression after radiotherapy for rectal cancer – Results from the randomised Stockholm III trial

Erlandsson

Lörinc

Ahlberg

et al. 2019

Radiotherapy and Oncology

112

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Section: Complications and Toxicitymentioning

confidence: 96%

Section: Radiotherapymentioning

confidence: 99%

Tumour regression after radiotherapy for rectal cancer – Results from the randomised Stockholm III trial

Erlandsson

Lörinc

Ahlberg

et al. 2019

Radiotherapy and Oncology

112

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“…Owing to the amount of on going research comparing and evaluating neoadjuvant chemoradiotherapy protocols (e.g., short-course, delayed short-course, long course), recommendations continue to evolve, and certainly there remains equipoise in this area. 5,7,[33][34][35] This is reflected in the guidelines we examined, which differed in their endorsement of specific neoadjuvant protocols, as there is no definitive evidence yet for clinical practice.…”

Section: E33mentioning

confidence: 99%

Management of rectal cancer in Canada: an evidence-based comparison of clinical practice guidelines

Mir

Merchant³

et al. 2020

CJS

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Background: Rectal cancer requires a multidisciplinary and multimodality treatment approach. Clinical practice guidelines (CPGs) provide a framework for delivering consistent, evidence-based health care. We compared provincial/territorial CPGs across Canada to identify areas of variability and evaluate their quality. Methods: We retrieved CPGs from Canadian organizations responsible for cancer care oversight and evaluated their quality and developmental methodology using the AGREE-II instrument. Recommendations for diagnostic and staging investigations, treatment by stage, and post-treatment surveillance of stage I-III rectal cancers were abstracted and compared. Results: We identified 7 sets of CPGs for analysis, varying in content, presentation, quality, and year last updated. Differences were noted in locoregional staging: 4 recommended magnetic resonance imaging over endorectal ultrasonography, 2 recommended either modality, and 3 specified scenarios for one over the other. Recommendations also varied for use of staging computed tomography of the chest versus chest radiography and for surgical management and indications for transanal excision. Recommendations for neoadjuvant therapy in stage II/III disease also differed: 3 guidelines recommended long-course chemoradiation over short-course radiation therapy alone, while 3 others recommended short-course radiation in specific clinical scenarios. Adjuvant chemotherapy for stage II/III disease was uniformly recommended, with variable protocols. The use of proctosigmoidoscopy and interval/duration of endoscopic post-treatment surveillance varied among guidelines. Conclusion: Canadian CPGs vary in their recommendations for staging, treatment, and surveillance of rectal cancer. Some of these differences reflect areas with limited definitive evidence. Consistent guidelines with uniform implementation across provinces/territories may lead to more equitable care to patients. Contexte : Le cancer rectal requiert une approche thérapeutique multidisciplinaire et multimodalité. Les guides de pratique clinique (GPC) procurent un cadre pour assurer la prestation de soins de santé constants reposant sur des données probantes. Nous avons comparé les GPC des provinces et des territoires canadiens pour identifier les secteurs où ils varient et pour en évaluer la qualité. Méthodes : Nous avons obtenu les GPC des organisations canadiennes responsables des soins oncologiques et nous avons évalué leur qualité et la méthodologie de leur élaboration au moyen de l'outil AGREE II (Appraisal of Guidelines for Research & Evaluation). Nous avons extrait et comparé les recommandations en ce qui concerne les épreuves diagnostiques et la stadification, les traitements en fonction du stade et la surveillance post-thérapeutique du cancer rectal de stade I à III. Résultats : Nous avons recensé 7 GPC aux fins de cette analyse; leur contenu, leur présentation, leur qualité et l'année de leur plus récente mise à jour variaient. Des différences ont été observées au plan de la stadification locorégi...

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“…Patients in the LCRT arm were more likely to have serious radiation dermatitis, and patients in the SCRT arm were more likely to have a permanent stoma. 10 , 11 The Stockholm III study showed noninferior oncologic outcomes with 2 SCRT regimens (immediate surgery and delayed interval to surgery) compared with LCRT. 12 Another trial comparing SCRT and LCRT, both with a delayed interval to surgery, showed greater tumor downstaging and downsizing with LCRT.…”

Section: Introductionmentioning

confidence: 99%

Utilization of short-course radiation therapy for patients with nonmetastatic rectal adenocarcinoma in the United States

Abdel‐Rahman

Elhalawani

Allen

et al. 2018

Advances in Radiation Oncology

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PurposePreoperative short-course radiation therapy (SCRT) for patients with nonmetastatic rectal adenocarcinoma has been studied in European trials, but is not often used in the United States. We aim to describe the utilization of preoperative SCRT among patients with nonmetastatic rectal cancer in the National Cancer Database and describe factors associated with its use.Methods and materialsThe National Cancer Database was queried for patients treated with preoperative radiation therapy followed by surgery for nonmetastatic rectal adenocarcinoma between 2004 and 2014. Patient, tumor, and treatment-related characteristics were compared between patients treated with SCRT (20-25 Gy in <7 fractions) and patients treated with long-course radiation therapy (45-70 Gy in ≥ 25 fractions). Univariate and multivariate Cox regression analyses were used to evaluate factors associated with overall survival. Survival rates were compared using an inverse-probability-weighted regression adjustment method.ResultsA total of 42,336 patients were included for analysis of which 41,867 patients (98.9%) were treated with long-course radiation therapy and 469 patients (1.1%) with SCRT. Patients treated with SCRT were older, had more comorbidities, had earlier T-stage, and were more likely to be clinically node-negative. Patients treated with SCRT were more likely to be treated at an academic center, have Medicare insurance, and be treated without chemotherapy. Patients treated with SCRT had lower pathological complete response rates (4.3% vs 6.9%; P < .001) and higher rates of positive circumferential resection margins (8.3% vs 5.2%; P = .001). On multivariate analysis, radiation fractionation was not significantly associated with overall survival.ConclusionsSCRT is used for only approximately 1% of patients treated preoperatively for nonmetastatic rectal cancer in the United States. The results of recently completed randomized trials may further inform patterns of practice in the United States and abroad.

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Acute Adverse Events and Postoperative Complications in a Randomized Trial of Preoperative Short-course Radiotherapy Versus Long-course Chemoradiotherapy for T3 Adenocarcinoma of the Rectum

Abstract: LC had significantly higher AEs compared with SC with no statistically significant differences in postoperative complications. There were clinical trends in permanent stoma rates and anastomotic leaks in favor of LC but with an increased perineal wound breakdown rate.

Cited by 86 publications

References 16 publications

Tumour regression after radiotherapy for rectal cancer – Results from the randomised Stockholm III trial

Tumour regression after radiotherapy for rectal cancer – Results from the randomised Stockholm III trial

Management of rectal cancer in Canada: an evidence-based comparison of clinical practice guidelines

Utilization of short-course radiation therapy for patients with nonmetastatic rectal adenocarcinoma in the United States

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