French current management and oncological results of locally recurrent rectal cancer

Denost, Quentin; Faucheron, Jean‐Luc; Lefèvre, Jérémie H.; Panis, Yves; Cotte, Eddy; Rouanet, Philippe; Jafari, Mehrdad; Capdepont, Maylis; Pezet,; Tuech,; Benchimol,; Massard,; Prudhomme,; Gainant,; Regimbeau,; Chenet,; Pautrat,; Paineau,; Peluchon,; Elias, Md.; Dumont,; Evrard,; Beaulieu,; Mabrut,; Vaudois,; Rio,; Gouthi,; Mauvais,; Bresler,; Boissel,; Tiret,; Glehen,; Rohr,; Sastre,; Fancois,; Singier,; Voirin,; Risse,; Quenet,; Joyeux,; Saint-Aubert,; Khalil, Khalil

doi:10.1016/j.ejso.2015.09.019

Cited by 19 publications

(13 citation statements)

References 39 publications

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“…In a multivariate analysis, including adjustment for R‐status, only R1 resection remained an independent significant risk factor for re‐recurrent disease or death. These results are in agreement with previous studies in the era of TME surgery .…”

Section: Discussionsupporting

confidence: 94%

Pelvic local recurrence from colorectal cancer: surgical challenge with changing preconditions

et al. 2018

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Section: Discussionsupporting

confidence: 94%

Pelvic local recurrence from colorectal cancer: surgical challenge with changing preconditions

et al. 2018

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“…The number of patients who were radiotherapy-naive differed between the two countries. Previous studies from France and Australia 5,19 reported that the R0 rate for LRRC was 20 per cent lower in patients who had not previously received pelvic radiotherapy. Although different rates of previous radiotherapy in the two countries may explain the difference in R0 rates, the most likely explanation is the higher rate of wide and more radical resection in Australia.…”

Section: Discussionmentioning

confidence: 91%

“…Global variation in practice may be explained by different healthcare systems and perhaps different medical cultures. Since 2008, the management of LRRC in France has been recorded in a prospective national database 5 . This has highlighted that there is no established national network for T4 primary and LRRC requiring complex pelvic surgery.…”

Section: Introductionmentioning

confidence: 99%

International variation in managing locally advanced or recurrent rectal cancer: prospective benchmark analysis

Denost

Solomon

Tuech

et al. 2020

British Journal of Surgery

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Background: Tumour extension beyond the mesorectal plane (ymrT4) occurs in 5-10 per cent of patients with rectal cancer and 10 per cent of patients develop locally recurrent rectal cancer (LRRC) after primary surgery. There is global variation in healthcare delivery for these conditions. Methods: An international benchmark trial of the management of ymrT4 tumours and LRRC was undertaken in France and Australia between 2015 and 2017. Heterogeneity in management and operative decision-making were analysed by comparison of surgical resection rates, blinded intercountry reading of pelvic MRI, quality-of-life assessment and qualitative evaluations. Results: Among 154 patients (97 in France and 57 in Australia), 31⋅8 per cent had ymrT4 disease and 68⋅2 per cent LRRC. The surgical resection rates were 88 and 79 per cent in France and Australia respectively (P = 0⋅112). The concordance in operative planning was low (= 0⋅314); the rate of pelvic exenteration was lower in France than Australia both in clinical practice (36 of 78 versus 34 of 40; P < 0⋅001) and in theoretical conditions (10 of 25 versus 50 of 57; P = 0⋅002). The R0 resection rate was lower in France than Australia for LRRC (25 of 49 versus 18 of 21; P = 0⋅007) but not for ymrT4 tumours (21 of 26 versus 15 of 15; P = 0⋅139). Morbidity rates were similar. Patients who underwent non-exenterative procedures had higher scores on the mental functioning subscale at 12 months (P = 0⋅047), and a lower level of distress at 6 months (P = 0⋅049). Qualitative analysis highlighted five categories of psychosocial factors influencing treatment decisions: patient, strategy, specialist, organization and culture. Conclusion: This international benchmark trial has highlighted the differences in worldwide treatment of locally advanced and LRRC. Standardized care should improve outcomes for these patients.

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“…The R0 resection rate in a French cohort of patients with LRRC with previous pelvic irradiation undergoing surgery was 55% [17]. Based on previous published literature, there is a 20% increase in the R0 resection rate in patients undergoing pelvic reirradiation.…”

Section: Methodsmentioning

confidence: 99%

A phase III randomized trial evaluating chemotherapy followed by pelvic reirradiation versus chemotherapy alone as preoperative treatment for locally recurrent rectal cancer – GRECCAR 15 trial protocol

et al. 2021

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Aim: Treatment strategies in locally recurrent rectal cancer (LRRC) are complex and need to be balanced against previous treatments received for the primary rectal cancer.Radiotherapy is an important component of treatment in LRRC. However, there is little high-quality evidence on the role of reirradiation in this cohort. Therefore, the aim of this trial is to assess the efficacy of neoadjuvant chemotherapy followed by pelvic reirradiation versus neoadjuvant chemotherapy alone on the rate of curative surgery (R0) in previously irradiated patients with LRRC.Method: GRECCAR 15 is a prospective, multicentre, open-label, outcome assessorblinded, superiority randomized controlled phase III clinical trial comparing neoadjuvant chemotherapy followed by pelvic reirradiation versus neoadjuvant chemotherapy alone in patients with LRRC previously irradiated for the primary cancer. Adult patients (>18 years old) with a histologically proven resectable LRRC, who have previously received pelvic radiotherapy for their primary rectal cancer at a dose of 25-50.4 Gy, and an Eastern Cooperative Oncology Group performance status of <2 will be eligible to participate. The pelvic reirradiation will consist of conformational intensity-modulated external irradiation, delivering a dose of 30.6 Gy with concomitant chemotherapy using capecitabine.The primary outcome of this trial is the R0 resection rate. Overall, GRECCAR 15 aims to recruit 186 patients to detect an absolute difference of 20% in the R0 resection rate with 80% power and 5% two-sided significance level. Conclusion:The GRECCAR 15 trial is the first, definitive, phase III trial to investigate reirradiation in LRRC. The results of this trial will inform definitively the neoadjuvant treatment strategy in previously irradiated patients and assess whether there is any associated benefit of reirradiation in combination with induction chemotherapy in improving R0 resection rates.

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French current management and oncological results of locally recurrent rectal cancer

Cited by 19 publications

References 39 publications

Pelvic local recurrence from colorectal cancer: surgical challenge with changing preconditions

Pelvic local recurrence from colorectal cancer: surgical challenge with changing preconditions

International variation in managing locally advanced or recurrent rectal cancer: prospective benchmark analysis

A phase III randomized trial evaluating chemotherapy followed by pelvic reirradiation versus chemotherapy alone as preoperative treatment for locally recurrent rectal cancer – GRECCAR 15 trial protocol

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