Adjuvant chemoradiotherapy instead of revision radical resection after local excision for high-risk early rectal cancer

Jeong, Jae‐Uk; Nam, Taek‐Keun; Kim, Hyeong–Rok; Shim, Hyungbo; Kim, Yong-Hyub; Yoon, Myung Ha; Song, Jong Tae; Ahn, Sung‐Ja; Chung, Woong‐Ki

doi:10.1186/s13014-016-0692-9

Cited by 25 publications

(26 citation statements)

References 21 publications

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“…In the Spanish study [18] 13 of 28 patients developed complications of radiotherapy (8 grade I, 5 grade II) and all were managed conservatively. The Korean study [21] noted early proctitis (grade 2) in 11% of patients. The same number showed asymptomatic proctitis later at follow-up.…”

Section: Adjuvant Radiotherapymentioning

confidence: 97%

“…Two more recent Asian studies used adjuvant CRT in a more structured regime for tumors with adverse histopathological features. A Korean study [21] looked at 83 patients after local excision; 70% had transanal excision and 30% underwent EMR or EMD. The standard adjuvant treatment was radiotherapy (50.4 Gy over 5 weeks) with concurrent chemotherapy.…”

Section: Adjuvant Radiotherapymentioning

confidence: 99%

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Adjuvant radiotherapy after local excision of rectal cancer

Jones

Cunningham

2019

Acta Oncologica

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Background: Local excision is now accepted as a standard treatment option for certain patients with early rectal cancer. However, there is a higher risk of local recurrence than after radical surgery with total mesorectal excision. Adjuvant radiotherapy after local excision may reduce this excess risk, and yet retain the benefits of local excision, with rectal preservation. Methods: A review of the literature pertaining to the use of adjuvant radiotherapy after local excision of rectal cancer and a discussion of current practice. Results: We first considered local excision as a treatment option for early rectal cancer, looking at technical developments and the risks and benefits of organ preservation, in particular, the advantages for quality of life and the risk of leaving residual disease which may result in local recurrence. We then looked at reported outcomes for studies using adjuvant radiotherapy after local excision. Few of the studies routinely used modern endoscopic methods of local excision and only the recent used chemoradiation. Local recurrence rates after adjuvant radiotherapy have improved over time, with rates of around 3.5% in the recent studies. Adverse effects of adjuvant radiotherapy are not commonly described, but generally, they are relatively mild when described. We then discussed current practice regarding adjuvant radiotherapy, including pathological criteria, discussion of local recurrence risk with the patient and the importance of a surveillance regime to detect any recurrence at an early stage. Conclusion: We conclude that the current state of knowledge regarding adjuvant radiotherapy after local excision suggests a potential role in decreasing the risk of local recurrence but further studies are required to better define this effect, clarify which patients will gain the most benefit from this pathway, and identify those who should avoid exposure to the risks of radiotherapy. ARTICLE HISTORY

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Section: Adjuvant Radiotherapymentioning

confidence: 97%

Section: Adjuvant Radiotherapymentioning

confidence: 99%

Adjuvant radiotherapy after local excision of rectal cancer

Jones

Cunningham

2019

Acta Oncologica

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“…A couple of more recent studies have used radiotherapy in a more formalized regime. A Korean study of 83 patients having chemoradiotherapy after local excision for high‐risk T1 and any T2 tumours recorded three instances of local recurrence (3.7%) at a median follow‐up of 5.1 years. Sasaki et al .…”

Section: Discussionmentioning

confidence: 99%

“…A couple of more recent studies have used radiotherapy in a more formalized regime. A Korean study [8] of 83 patients having chemoradiotherapy after local excision for high-risk T1 and any T2 tumours recorded three instances of local recurrence (3.7%) at a median follow-up of 5.1 years. Sasaki et al [9] reported a multicentre Japanese clinical trial in which 57 patients with low rectal cancer received chemoradiotherapy after local excision.…”

Section: Discussionmentioning

confidence: 99%

Radiotherapy after local excision of rectal cancer may offer reduced local recurrence rates

et al. 2019

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Aim Early rectal cancer can be managed effectively with local excision, which is now the standard of care for many T1 lesions. However, the presence of unexpected adverse histopathological factors may indicate an increased risk of local recurrence, prompting consideration of completion radical surgery. Many patients are unfit or prefer to avoid radical surgery, relying instead on surveillance and early detection of recurrent disease. Recently, radiotherapy has shown promise as an adjuvant therapy in this group. This study assesses local recurrence rates after local excision with adjuvant radiotherapy at a single centre. Method This was a retrospective review of a prospective database of all patients undergoing transanal endoscopic microsurgery (TEM) in a single institution. Data covering a 10‐year period were analysed. Results Of 197 patients undergoing TEM for rectal cancer, 33 (17%) had adjuvant radiotherapy because of adverse histopathological features. At 3.2 years’ median follow‐up, there were three instances of local recurrence (9.1%). Estimated local recurrence at 1 and 3 years was 0% and 6.9%, compared to 16.8% and 21.2% in a propensity‐score‐matched group who were followed by surveillance alone. Local recurrence was diagnosed at a median of 23 months post‐TEM in the radiotherapy group, compared to 8 months in the matched group. Conclusion Radiotherapy after TEM is associated with a trend towards a reduced rate of local recurrence, even for high‐risk disease. Radiotherapy would appear to offer a viable alternative to radical completion surgery in the presence of unforeseen adverse histopathological features, as long as a meticulous surveillance programme is in place.

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“…Regarding postoperative chemo/radiotherapy, NCCN supported this indication for T1–2 tumours after transanal excision, mainly as an alternative to radical surgery. In the same way, only NCCN guidelines advised adjuvant treatment for stage II cancer.…”

Section: Discussionmentioning

confidence: 99%