Adjuvant radiotherapy for the treatment of stage IV rectal cancer after curative resection

Kim, Min Jung; Kim, Sang Jin; Park, Sung Chan; Kim, Dae Yong; Park, Ji Won; Ryoo, Seung Bum; Jeong, Seung Yong; Park, Kyu Joo; Oh, Heung Kwon; Kim, Duck Woo; Kang, Sung Bum; Joo, Jung Nam; Oh, Jae Hwan

doi:10.1097/md.0000000000004925

Cited by 6 publications

(5 citation statements)

References 21 publications

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“…Also in 2012, a study in Korea believed that the survival benefit of RT in mRC was not apparent after an analysis of 68 patients with metastatic rectal cancer 29. Similarly, Min et al 22 analyzed 176 patients with mRC who underwent TME and reported that pelvic RT might have benefits in locoregional control, yet the survival difference was not significantly different between the RT and no-RT groups after surgery. From the above it can be seen that the previous studies suggested that the survival benefit in mRC was not apparent or inconclusive.…”

Section: Discussionmentioning

confidence: 99%

Palliative beam radiotherapy offered real-world survival benefit to metastatic rectal cancer: A large US population-based and propensity score-matched study

et al. 2019

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Purpose : Radiotherapy (RT) has been reported to effectively palliate many symptoms of patients with metastatic rectal cancer (mRC). The objective of this study was to evaluate the survival benefit of RT in mRC. Methods : A retrospective population-based cohort study was performed using the Surveillance, Epidemiology, and End Results Program (SEER) database. Patient baseline demographic characteristics between the RT and no-RT groups were compared using Pearson chi-square tests. The outcome of interest was cause-specific survival (CSS). Propensity score (PS) matching and Cox proportional hazards regression analyses were performed to evaluate the prognostic power of variables on CSS. Results : A total of 8851 patients with mRC were identified in the SEER database. Multivariable Cox regression analysis showed that RT was a protective factor in mRC (hazard ratio [HR]= 0.702, 95% confidence interval [CI]=0.665-0.741, p<0.001). In subgroup analysis, multivariate Cox analysis demonstrated that patients of both surgery and no-surgery subgroups treated with RT had better CSS than those not treated with RT (HR=0.654, 95%CI=0.607-0.704, p<0.001 for the surgery group; HR=0.779, 95%CI=0.717-0.847, p<0.001 for the no-surgery group), PS matching resulted in 4170 mRC patients and RT group presented significantly improved survival benefit than no-RT group (22.0 vs. 13.5%, P <0.001). In surgery subgroup after PS matching, in especial, RT group showed more evidently improved survival benefit than no-RT group (30.3 vs. 18.0%, p <0.001). Conclusion : Using the SEER database, we definitely demonstrated that RT was associated with a significant survival advantage beyond the relief of a variety of pelvic symptoms in the setting of mRC. This study strongly supports the use of RT in selected patients with mRC, especially in patients who have undergone surgery. More studies need to be conducted to accurately define the role of RT in mRC.

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Section: Discussionmentioning

confidence: 99%

Palliative beam radiotherapy offered real-world survival benefit to metastatic rectal cancer: A large US population-based and propensity score-matched study

et al. 2019

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“…The findings suggested that the LR-free survival (LRFS) rate in the RT group was significantly higher than that in the non-RT group (2-year LRFS: 100% vs. 83.6%, P =0.038). At the same time, the results of their meta-analysis showed that the risk of LR was lower in the RT group than in the non-RT group (17). From this, pelvic RT may be seen as beneficial to the local control (LC) of patients with stage IV rectal cancer, however, no significant difference was observed in the OS between the two groups.…”

Section: Discussionmentioning

confidence: 99%

Survival analysis and prognostic factors of palliative radiotherapy in patients with metastatic colorectal cancer: a propensity score analysis

Wang

Zhu

et al. 2021

J Gastrointest Oncol

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Background: Radiation therapy (RT) is known to have beneficial effects on the palliative treatment of patients with advanced cancer. However, valid data on this treatment method are limited, especially for patients with metastatic colorectal cancer (mCRC). This study aimed to identify prognostic factors and investigate the outcomes of mCRC patients who received palliative RT.Methods: A total of 488 mCRC patients who underwent systemic therapy with or without palliative RT between 2014 and 2019 were included in the study. Of the 488 patients, 155 received systemic treatment combined with palliative RT (RT group), while 333 were only administered systemic treatment (non-RT group). Propensity score matching (PSM) was conducted to eliminate possible bias, and overall survival (OS) was calculated using the Kaplan-Meier (KM) method. A log-rank test was used to compare the survival outcomes of each group, and a multivariate analysis was conducted using a Cox proportional hazards model. Results:The RT group had a higher OS than that of the non-RT group (P=0.001). After PSM, the median OS of the RT group was 50.8 months, and for the non-RT group it was 32.2 months (P=0.003). Subgroup analysis revealed that RT had a better effect on the OS of patients who had synchronous metastasis, or who didn't receive targeted therapy or local treatment (including surgery, ablation, and intervention). Multivariate analysis of the whole cohort showed that palliative RT was associated with improved OS. Moreover, multivariate analysis of the RT group showed that systemic therapy before RT, and the site of RT was in the liver and lung, were independent prognostic factors affecting survival time.Conclusions: We demonstrated that systemic treatment followed by palliative RT led to a better OS for mCRC patients. This combination method can therefore be seen as a suitable treatment approach for patients with mCRC.

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“…Kim et al 294 performed a propensity score-matched analysis and meta-analysis of published literature of patients with stage IV rectal cancer who underwent TME between August 2001 and December 2011 to evaluate the impact of RT on oncologic outcomes. Two groups of 39 patients each were stratified based on patients receiving adjuvant pelvic RT (RT group) and those who did not (non-RT group) using their propensity scores.…”

Section: Standards For the Treatment Of Loco-regional Recurrencesmentioning

confidence: 99%

“…The local recurrence-free survival (LRFS) of the RT group was significantly higher than that of the non-RT group (2-year LRFS: 100% vs 83.6%, respectively, P = .038), while the overall DFA and distant metastasis-free survival rates were similar for both groups; adjuvant pelvic RT was highlighted to improve loco-regional control in patients with stage IV rectal cancer eligible for TME. 294 …”

Section: Standards For the Treatment Of Loco-regional Recurrencesmentioning

confidence: 99%

Optimizing the Personalized Care for the Management of Rectal Cancer: A Consensus Statement

Aytaç

Özer

Baca

et al. 2022

Turk J Gastroenterol

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Colorectal cancer is the third most common cancer in Turkey. The current guidelines do not provide sufficient information to cover all aspects of the management of rectal cancer. Although treatment has been standardized in terms of the basic principles of neoadjuvant, surgical, and adjuvant therapy, uncertainties in the management of rectal cancer may lead to significant differences in clinical practice. In order to clarify these uncertainties, a consensus program was constructed with the participation of the physicians from the Acıbadem Mehmet Ali Aydınlar and Koç Universities. This program included the physicians from the departments of general surgery, gastroenterology, pathology, radiology, nuclear medicine, medical oncology, radiation oncology, and medical genetics. The gray zones in the management of rectal cancer were determined by reviewing the evidence-based data and current guidelines before the meeting. Topics to be discussed consisted of diagnosis, staging, surgical treatment for the primary disease, use of neoadjuvant and adjuvant treatment, management of recurrent disease, screening, follow-up, and genetic counseling. All those topics were discussed under supervision of a presenter and a chair with active participation of related physicians. The consensus text was structured by centralizing the decisions based on the existing data.

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Adjuvant radiotherapy for the treatment of stage IV rectal cancer after curative resection

Abstract: Supplemental Digital Content is available in the text

Cited by 6 publications

References 21 publications

Palliative beam radiotherapy offered real-world survival benefit to metastatic rectal cancer: A large US population-based and propensity score-matched study

Palliative beam radiotherapy offered real-world survival benefit to metastatic rectal cancer: A large US population-based and propensity score-matched study

Survival analysis and prognostic factors of palliative radiotherapy in patients with metastatic colorectal cancer: a propensity score analysis

Optimizing the Personalized Care for the Management of Rectal Cancer: A Consensus Statement

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