Prognosis of rectal cancer patients improves with downstaging by intensified neoadjuvant radiochemotherapy - a matched pair analysis

Schiffmann, Leif; Klautke, Günther; Wedermann, Nicole; Gock, Michael; Prall, Friedrich; Fietkau, Rainer; Rau, Bettina; Klar, E.

doi:10.1186/1471-2407-13-388

Cited by 8 publications

(5 citation statements)

References 28 publications

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“…The studies have shown that there is an association between the complete tumor response to neoadjuvant chemoradiation for rectal cancer and the histopathological and genetic characteristics, tumor stage and lymph node involvement (12,13). According to some authors, the tumor local response may be up to 25-40% (13) or even 92.5% in highly-selected cases (14).…”

Section: Discussion Discussionmentioning

confidence: 99%

Sphincter-Sparing Surgery in Patients with Mid and Low Rectal Cancer - Risk Factors for Local Recurrence and Anastomotic Leakage

Aslan¹,

Grama²,

Cristian³

et al. 2016

chr

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The purpose of this article is to identify the risk factors for local recurrence and anastomotic leakage after sphincter-sparing surgery for low and mid rectal cancer. Material and We prospectively analyzed a group of 38 patients with low and middle rectal cancer who underwent sphincter-sparing surgery. Low anterior resection was performed in 32 cases (84.2%) and 6 cases (15.8%) benefited of ultralow anterior resection. Clinical stadialization cTNM included 3 patients (7.9%) T1 stage, 11 patients (28.9%) T2 stage and 24 patients (63.2%) T3 stage. Preoperative radiotherapy was performed in 33 cases (86.4%), and chemotherapy was associated in 20 cases (52.6%). The stages I and II cancers were prevalent (63.2%), followed by stage III cancers (23.7%) and stage IV cancers (13.2%). The rate of complications of 52.6% (20 cases) was associated with T3 stage cancers. Anastomotic leakage has occurred in 4 cases (10.5%) and tumor recurrence has developed in 3 cases (7.9%). The rate of local recurrence and anastomotic leakage is associated with the number of positive lymph nodes (more than 4 nodes, 5.3%, p = 0.023). We found no association between chemoradiotherapy and the risk of local recurrence (p 0.05). Other postoperative complications included intestinal obstruction by adhesions or bowel volvulus (5 cases, 13.2%), postradiation colitis (3 cases, 7.7%), coloanal anastomotic stenosis (1 case, 2.6%), rectovaginal fistula (1 case, 2.6%), ileostomy bleeding (1 case, 2.6%), wound infection (2 cases, 5.3%). Risk factors associated with local recurrence and anastomotic leakage are aggressive stage tumor, lymphnodes involvement, neoadjuvant therapy and postoperative anemia. The postoperative outcome was favorable after sphincter preservation surgery and the absence of definitive colostomy had an important impact on the quality of life of the patients with distal rectal cancer.

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Section: Discussion Discussionmentioning

confidence: 99%

Sphincter-Sparing Surgery in Patients with Mid and Low Rectal Cancer - Risk Factors for Local Recurrence and Anastomotic Leakage

Aslan¹,

Grama²,

Cristian³

et al. 2016

chr

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“…For pretherapeutic clinical staging, a clinical history of the patients was taken and patients had a clinical examination as well as rigid rectoscopy to determine the distance of the lowest tumor border from the anal verge, colonoscopy, endosonographic ultrasound and/or imaging studies of the pelvis (MRI or CT), a CT scan and/or ultrasound examination of the abdomen, liver function tests, and chest X-ray, or CT of the thorax; additional imaging studies were done in the case of suspected metastatic disease. Details of the neoadjuvant therapy and the surgical procedures have been published previously [ 6 ]. Briefly, patients received pelvic radiation of 1.8 Gy single dose five days a week, adding up to 50.4 Gy (years 2000 to 2002; N = 20) or 55.8 Gy (after 2002; N = 84); this was complemented by chemotherapy with 5-FU or capecetabine and irinotecan or oxaliplatin.…”

Section: Methodsmentioning

confidence: 99%

Tumor regression in rectal cancer after intensified neoadjuvant chemoradiation: a morphometric and clinicopathological study

2015

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BackgroundHigh interobserver variation is a well known drawback of conventional tumor regression grading, and reaching consensus among pathologists may require a considerable effort. Therefore, in this study, morphometry was tried to assess tumor regression, and its prognostic role was explored.MethodsTumor regression was quantified by a point counting method to yield tumor area fraction (TAF) as an index of remaining vital tumor.ResultsIn a series of 104 patients with clinically advanced rectal cancer treated with neoadjuvant radiochemotherapy, TAFs were distributed continuously towards complete regression which was observed in 8.7% of the cases. Plotting TAFs grouped by a conventional regression grading (Dworak’s) revealed considerable overlap between groups. In a control series of untreated cancers, only TAFs of cancers with an expansive invasive border were setoff clearly from TAFs obtained for the study cases, but TAFs of control cases with an infiltrative invasive border and mucinous carcinomas extended well into the range of TAFs recorded for regressing tumors. Locoregional recurrence (N = 10) was significantly associated with perineural tumor infiltration and capsule transgressing lymph node metastasis/tumor deposits but not with the degree of tumor regression. Overall survival was better for patients with major regressions (≤20th percentile by morphometry, or Dworak regression grade (DRG) 4/5), although statistical significance was not reached.ConclusionsMorphometry of tumor regression is feasible and explains why conventional regression grading is so difficult to perform. Assessment of tumor regression, by subjective grading or morphometry, does not appear to convey major prognostic information, at least not substantially beyond histopathological tumor staging. This observation discourages expending too much effort on developing this aspect of the pathomorphological workup of the resection specimens.Electronic supplementary materialThe online version of this article (doi:10.1186/s12957-015-0572-z) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

“…Previously, we and other working groups have shown that neoadjuvant RCT (nRCT) leads to improved cancer-related survival and disease-free survival on the one hand, but also to more complications and potentially impaired function on the other. [1][2][3] Endoscopic vacuum therapy (EVT) has become the treatment of choice for anastomotic leaks after rectal resections in various institutions. Suction and drainage via an open-pored polyurethane sponge decrease bacterial contamination, secretion, and local edema.…”

Section: Introductionmentioning

confidence: 99%

Neoadjuvant radio-chemotherapy prolongs healing of anastomotic leakage after rectal resection treated with endoscopic vacuum therapy

Schiffmann

Wedermann

Schwandner

et al. 2019

Therap Adv Gastroenterol

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Background: Neoadjuvant radiochemotherapy (nRCT) is an important component in the treatment of advanced rectal cancer. Endoscopic vacuum therapy (EVT) has become the treatment of choice for anastomotic leakage after rectal resection in many institutions in Germany. Published case series report on average success and stoma reversal rates of more than 80%. However, so far, there is no distinct report on the potential influence of nRCT on EVT. Methods: A total of 11 patients treated with EVT for anastomotic leakage after nRCT and rectal resection were retrospectively compared with a cohort of eight patients with rectal anastomotic leakage without neoadjuvant treatment. Primary endpoints were death, treatment success, and long-term preservation of intestinal continuity. Secondary endpoint was the duration of treatment. Statistical analysis was performed using Statistical Package for Social Science (SPSS) version 23.0. Results: There was no difference in mortality (0%), success rate (90.9% versus 100%, p = 0.381), or long-term preservation of continuity (63.6% versus 62.5%, p = 0.960). After nRCT, patients showed a significant longer duration of EVT (31.1 days versus 15.9 days, p = 0.040) which was associated with a significantly higher number of sponge applications (9.6 versus 5.0, p = 0.042). Conclusions: In our analysis, EVT showed success in over 90% of patients with anastomotic leakage after rectal resection for colorectal cancer, regardless of neoadjuvant treatment. However, in case of anastomotic leakage, nRCT seems to be associated with the need for a significant longer duration of EVT.

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Prognosis of rectal cancer patients improves with downstaging by intensified neoadjuvant radiochemotherapy - a matched pair analysis

Cited by 8 publications

References 28 publications

Sphincter-Sparing Surgery in Patients with Mid and Low Rectal Cancer - Risk Factors for Local Recurrence and Anastomotic Leakage

Sphincter-Sparing Surgery in Patients with Mid and Low Rectal Cancer - Risk Factors for Local Recurrence and Anastomotic Leakage

Tumor regression in rectal cancer after intensified neoadjuvant chemoradiation: a morphometric and clinicopathological study

Neoadjuvant radio-chemotherapy prolongs healing of anastomotic leakage after rectal resection treated with endoscopic vacuum therapy

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