Impact of interval between neoadjuvant chemoradiotherapy and surgery for rectal cancer on surgical and oncologic outcome

Zeng, Weigen; Zhou, Zhixiang; Liang, Jianwei; Wang, Zheng; Hou, Hui-rong; Zhou, Haitao; Zhang, Xingmao; Hu, Junjie

doi:10.1002/jso.23665

Cited by 38 publications

(31 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Both sphincter preservation (OR 1⋅00, 95 per cent c.i. 0⋅88 to 1⋅14; P = 0⋅95) and stoma formation (OR 1⋅06, 0⋅83 to 1⋅36; P = 0⋅63) rates were similar for the Tran et al 22 Tulchinsky et al 23 De Campos-Lobato et al 24 Wolthuis et al 25 Saglam et al 33 Jeong et al 43 You et al 44 Zeng et al 46 Sirohi et al 45 Mihmanlı et al 49 Akbar et al 26 Garrer et al 50 Tran et al 22 Stein et al 21 Tulchinsky et al 23 De Campos-Lobato et al 24 Wolthuis et al 25 Jeong et al 43 You et al 44 Zeng et al 46 Sirohi et al 45 Akbar et al 26 Garrer et al 50 11 longer versus shorter interval (Figs S8-S10, supporting information).…”

Section: Duration Of Surgery Sphincter Preservation and Covering Stomentioning

confidence: 81%

“…). A total of 26 publications, including four RCTs and 25 445 patients with rectal cancer were eligible for inclusion ( Table ). Twenty‐four of the 26 studies (22 650 patients) reported the primary endpoint of pCR based on the predefined wait interval and were included in the qualitative and quantitative analysis for this outcome variable; 15·9 per cent (1522 of 9551) and 11·3 per cent (1481 of 13 099) had achieved pCR in the extended and classical intervals respectively.…”

Section: Resultsmentioning

confidence: 99%

“…Thirty-day mortality and local recurrence, distant metastasis, RFS and overall survival (OS) rates were also evaluated. Stein et al 21 Tran et al 22 Tulchinsky et al 23 De Campos-Lobato et al 24 Evans et al 32 Garcia-Aguilar et al 31 Wolthuis et al 25 Saglam et al 33 Jeong et al 43 You et al 44 Zeng et al 46 Sirohi et al 45 Probst et al 47 Mihmanlı et al 49 Timudom et al 48 Akbar et al 26 Lefevre et al 35 Kwak et al 51 Foster et al 34 Garrer et al 50 Lee et al 52 Kuan et al 53 Akgun et al 36 Kim et al 54…”

Section: Secondary Outcomesmentioning

confidence: 99%

“…There was no difference in reoperation (OR 1⋅25, 0⋅57 to 2⋅71; P = 0⋅58) or postoperative mortality (OR 1⋅13, 0⋅75 to 1⋅71, P = 0⋅56; risk difference of 0 per cent) rates between the groups ( Table 2) (Figs S11-S21, supporting information). Tran et al 22 Tulchinsky et al 23 De Campos-Lobato et al 24 Wolthuis et al 25 Saglam et al 33 Jeong et al 43 You et al 44 Zeng et al 46 Mihmanli et al 49 Akbar et al 26 Garrer…”

Section: Blood Loss Reoperation and Complication Ratesmentioning

confidence: 99%

See 3 more Smart Citations

Meta-analysis of the effect of extending the interval after long-course chemoradiotherapy before surgery in locally advanced rectal cancer

Ryan

O’Sullivan

Kelly

et al. 2019

British Journal of Surgery

View full text Add to dashboard Cite

Background The current standard of care in locally advanced rectal cancer (LARC) is neoadjuvant long‐course chemoradiotherapy (nCRT) followed by total mesorectal excision (TME). Surgery is conventionally performed approximately 6–8 weeks after nCRT. This study aimed to determine the effect on outcomes of extending this interval. Methods A systematic search was performed for studies reporting oncological results that compared the classical interval (less than 8 weeks) from the end of nCRT to TME with a minimum 8‐week interval in patients with LARC. The primary endpoint was the rate of pathological complete response (pCR). Secondary endpoints were recurrence‐free survival, local recurrence and distant metastasis rates, R0 resection rates, completeness of TME, margin positivity, sphincter preservation, stoma formation, anastomotic leak and other complications. A meta‐analysis was performed using the Mantel–Haenszel method. Results Twenty‐six publications, including four RCTs, with 25 445 patients were identified. A minimum 8‐week interval was associated with increased odds of pCR (odds ratio (OR) 1·41, 95 per cent c.i. 1·30 to 1·52; P < 0·001) and tumour downstaging (OR 1·18, 1·05 to 1·32; P = 0·004). R0 resection rates, TME completeness, lymph node yield, sphincter preservation, stoma formation and complication rates were similar between the two groups. The increased rate of pCR translated to reduced distant metastasis (OR 0·71, 0·54 to 0·93; P = 0·01) and overall recurrence (OR 0·76, 0·58 to 0·98; P = 0·04), but not local recurrence (OR 0·83, 0·49 to 1·42; P = 0·50). Conclusion A minimum 8‐week interval from the end of nCRT to TME increases pCR and downstaging rates, and improves recurrence‐free survival without compromising surgical morbidity.

show abstract

Section: Duration Of Surgery Sphincter Preservation and Covering Stomentioning

confidence: 81%

Section: Resultsmentioning

confidence: 99%

Section: Secondary Outcomesmentioning

confidence: 99%

Section: Blood Loss Reoperation and Complication Ratesmentioning

confidence: 99%

See 2 more Smart Citations

Meta-analysis of the effect of extending the interval after long-course chemoradiotherapy before surgery in locally advanced rectal cancer

Ryan

O’Sullivan

Kelly

et al. 2019

British Journal of Surgery

View full text Add to dashboard Cite

show abstract

“…Studies have also found a number of treatment-related variables that are associated with a higher likelihood of complete response, including the interval from the end of radiation to surgery, 19,20,23,27,32,40–42 type of concurrent chemotherapy used, 43 and radiation dose. 44–46 In particular, the interval from the end of radiation to surgery has been of special interest and has been directly addressed by multiple studies as well as a meta-analysis.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Pathologic Complete Response Following Neoadjuvant Chemoradiotherapy for Rectal Cancer

et al. 2015

View full text Add to dashboard Cite

Background Some patients with rectal cancer who receive neoadjuvant chemoradiotherapy (nCRT) achieve a pathologic complete response (pCR) and may be eligible for less radical surgery or non-operative management. The aim of this study was to identify variables that predict pCR after nCRT for rectal cancer and to examine the impact of pCR on postoperative complications. Methods A retrospective review was performed of the NCDB from 2006 to 2011. Patients with rectal cancer who received nCRT followed by radical resection were included in this study. Multivariable analysis of the association between clinicopathologic characteristics and pCR was performed, and propensity-adjusted analysis was used to identify differences in postoperative morbidity between pCR and non-pCR patients. Results A total of 23,747 patients were included in the study. Factors associated with pCR included lower tumor grade, lower clinical T and N stage, higher radiation dose, and delaying surgery by more than 6–8 weeks after the end of radiation, while lack of health insurance was linked with a lower likelihood of pCR. Complete response was not associated with an increased risk of major postoperative complications. Conclusions Several clinical, pathologic, and treatment variables can help to predict which patients are most likely to have pCR after nCRT for rectal cancer. Awareness of these variables can be valuable in counseling patients regarding prognosis and treatment options.

show abstract

Effect of interval between preoperative radiotherapy and surgery on clinical outcome and radiation proctitis in rectal cancer from FOWARC trial

et al. 2019

View full text Add to dashboard Cite

Objective: The aim of this study was to evaluate the effect of the interval between CRT and surgery on radiation proctitis, the pathologic response, and postoperative morbidity. Methods: This was a cohort study from a phase III, randomized controlled trial (FOWARC study, NCT01211210). Data were retrieved from the leading center of the trial. Patients were divided into the short-interval (≤7 weeks) group and the longinterval (>7 weeks) group. The rate of radiation proctitis, pathologic complete regression (pCR) and morbidities were calculated for each group. Multivariate analysis was used to verify the impact of interval on radiation proctitis. Results: Surgery was performed in 60 patients after an interval of ≤7 weeks and in 97 patients after an interval of >7 weeks. The two groups according to interval were comparable in terms of baseline demographic and clinicotherapeutic characteristics.Radiation proctitis was identified by imaging in 9 (15.0%) patients in short-interval group and in 31 (32.0%) patients in long-interval group (P = .018). Multivariate analysis confirmed the correlation between long interval and radiation proctitis (P = .018). The long interval was significantly associated with longer median operation time compared to the short interval (P = .022). The rates of pCR and postoperative complications were not different between two groups. Conclusions: A longer interval after CRT may be associated with higher rate of radiation proctitis and longer operation time. Moreover it did not increase the rate of pCR. | 913CHENG Et al.

show abstract

Impact of interval between neoadjuvant chemoradiotherapy and surgery for rectal cancer on surgical and oncologic outcome

Abstract: A neoadjuvant-surgery interval >7 weeks is safe and is associated with a higher rate of pCR and R0 resection, and decreased local recurrence.

Cited by 38 publications

References 28 publications

Meta-analysis of the effect of extending the interval after long-course chemoradiotherapy before surgery in locally advanced rectal cancer

Meta-analysis of the effect of extending the interval after long-course chemoradiotherapy before surgery in locally advanced rectal cancer

Predictors of Pathologic Complete Response Following Neoadjuvant Chemoradiotherapy for Rectal Cancer

Effect of interval between preoperative radiotherapy and surgery on clinical outcome and radiation proctitis in rectal cancer from FOWARC trial

Contact Info

Product

Resources

About