Individual participant data pooled-analysis of risk factors for recurrence after neoadjuvant radiotherapy and transanal local excision of rectal cancer: the PARTTLE study

Arezzo, Alberto; Secco, Giacomo Lo; Passera, Roberto; Esposito, Laura; Guerrieri, Mario; Ortenzi, Monica; Bujko, Krzysztof; Perez, Rodrigo Oliva; Habr‐Gama, Angelita; Stipa, F; Picchio, Marcello; Restivo, Angelo; Zorcolo, Luigi; Coco, Claudio; Rizzo, Gianluca; Mistrangelo, Massimiliano; Morino, Mario

doi:10.1007/s10151-019-02049-z

Cited by 17 publications

(13 citation statements)

References 19 publications

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“…In a recent individual participant data pooled-analysis of published studies on rectal cancer surgery, logistic regression models were estimated for the risk of local, systemic and overall recurrence, showing a higher local and overall recurrences for ypT3 stage, tumor size after radiotherapy > 10 mm and lack of combined chemotherapy, while ypT3 was the only factor correlated with systemic recurrence [ 166 ].…”

Section: Resultsmentioning

confidence: 99%

Multidisciplinary management of elderly patients with rectal cancer: recommendations from the SICG (Italian Society of Geriatric Surgery), SIFIPAC (Italian Society of Surgical Pathophysiology), SICE (Italian Society of Endoscopic Surgery and new technologies), and the WSES (World Society of Emergency Surgery) International Consensus Project

et al. 2021

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Background and aims Although rectal cancer is predominantly a disease of older patients, current guidelines do not incorporate optimal treatment recommendations for the elderly and address only partially the associated specific challenges encountered in this population. This results in a wide variation and disparity in delivering a standard of care to this subset of patients. As the burden of rectal cancer in the elderly population continues to increase, it is crucial to assess whether current recommendations on treatment strategies for the general population can be adopted for the older adults, with the same beneficial oncological and functional outcomes. This multidisciplinary experts’ consensus aims to refine current rectal cancer-specific guidelines for the elderly population in order to help to maximize rectal cancer therapeutic strategies while minimizing adverse impacts on functional outcomes and quality of life for these patients. Methods The discussion among the steering group of clinical experts and methodologists from the societies’ expert panel involved clinicians practicing in general surgery, colorectal surgery, surgical oncology, geriatric oncology, geriatrics, gastroenterologists, radiologists, oncologists, radiation oncologists, and endoscopists. Research topics and questions were formulated, revised, and unanimously approved by all experts in two subsequent modified Delphi rounds in December 2020–January 2021. The steering committee was divided into nine teams following the main research field of members. Each conducted their literature search and drafted statements and recommendations on their research question. Literature search has been updated up to 2020 and statements and recommendations have been developed according to the GRADE methodology. A modified Delphi methodology was implemented to reach agreement among the experts on all statements and recommendations. Conclusions The 2021 SICG-SIFIPAC-SICE-WSES consensus for the multidisciplinary management of elderly patients with rectal cancer aims to provide updated evidence-based statements and recommendations on each of the following topics: epidemiology, pre-intervention strategies, diagnosis and staging, neoadjuvant chemoradiation, surgery, watch and wait strategy, adjuvant chemotherapy, synchronous liver metastases, and emergency presentation of rectal cancer.

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Section: Resultsmentioning

confidence: 99%

Multidisciplinary management of elderly patients with rectal cancer: recommendations from the SICG (Italian Society of Geriatric Surgery), SIFIPAC (Italian Society of Surgical Pathophysiology), SICE (Italian Society of Endoscopic Surgery and new technologies), and the WSES (World Society of Emergency Surgery) International Consensus Project

et al. 2021

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“…It becomes more challenging to differentiate fibrosis from residual viable tumors especially after PCRT. Studies report a poor correlation of post-PCRT imaging and pathologic results, showing an accuracy of 47% to 52% in T stage and 64% to 68% in N stage, with an overall accuracy reported to be approximately 68% to 72% in diffusion-weighted imaging [ 15 , 24 , 25 , 26 ]. Detecting the reduction of the tumor metabolism after PCRT is continuously studied to predict the pathologic response of the treatment by establishing a response predictive model with PET-CT [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison between Local Excision and Radical Resection for the Treatment of Rectal Cancer in ypT0-1 Patients: An Analysis of the Clinicopathological Factors and Survival Rates

Park

Kim

et al. 2021

Cancers

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Tumors with good response to preoperative chemoradiotherapy have a favorable prognosis, and these findings raise interest in rectum-sparing strategies. This study aimed to compare the oncologic outcome between local excision and radical resection in ypT0-1 patients and to analyze prognostic factors. Patients with primary rectal cancer diagnosed with ypT0-1 after PCRT followed by either radical resection (RR) or local excision (LE) between 2005 and 2014 were included in this study (LE = 78, RR = 442). Clinicopathologic features, recurrence-free survival (RFS), and OS were analyzed. There was no statistically significant difference in the RFS and OS between the LE and RR groups. Clinical T stage (cT3-4) before PCRT was related to RFS and in the LE group (p = 0.022). Lymph node metastasis (HR: 4.884, 95% confidence interval: 2.451–9.732, p < 0.001) in the final pathology was the only factor associated with RFS, showing a statistically significant difference in the RR group. Lymph node metastasis and age were associated with OS in the RR group. This study confirms the oncologic feasibility of LE in ypT0-1 rectal cancer after PCRT. Additionally, careful patient selection with higher accuracy modalities should be updated to improve treatment outcomes of LE.

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“…Also, no significant difference was found in R0 resection rate, sphincter preservation rate, permanent stoma rate, postoperative complication, mortality, and overall survival 49 . Dose-escalated radiotherapy could be associated with higher pCR rates 47,50 . However, this is not yet confirmed by a randomized controlled trial and could therefore not be further investigated in the present study 6 .…”

Section: Discussionmentioning

confidence: 99%

“…Novel neoadjuvant treatment strategies for frail patients are needed in order to increase their eligibility for organ-sparing treatments, while focusing on a balance between morbidity on the one hand and optimal function and cure rates on the other. Current studies investigate a combination of short-course radiotherapy and chemotherapy, resulting in increased pCR rates 22,23,27,29,50 . However, the risk of toxicity associated with this strategy is likely to be unacceptable in the frail rectal cancer patient.…”

Section: Discussionmentioning

confidence: 99%

“…A randomized trial comparing local excision with TME surgery in LARC patients is not available yet; the results of the Spanish PRONAR trial (NCT03064646) and the Italian observational ReSARCh study are still awaited 48,49 . Lastly, it must be emphasized that local excision in an irradiated rectum may compromise tissue healing, leading to partial or complete dehiscence and subsequent morbidity, including anal pain or the need for a diverting ostomy 44,50 . For now, local excision should be reserved for selected patients, like those who are unfit for major surgery or who are treated with a palliative intent 50 .…”

Section: Surgical Outcomesmentioning

confidence: 99%

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Connecting the dots: a multidisciplinary approach to optimize rectal cancer treatment outcomes

Hoendervangers¹

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Individual participant data pooled-analysis of risk factors for recurrence after neoadjuvant radiotherapy and transanal local excision of rectal cancer: the PARTTLE study

Cited by 17 publications

References 19 publications

Comparison between Local Excision and Radical Resection for the Treatment of Rectal Cancer in ypT0-1 Patients: An Analysis of the Clinicopathological Factors and Survival Rates

Connecting the dots: a multidisciplinary approach to optimize rectal cancer treatment outcomes

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