Is long interval from neoadjuvant chemoradiotherapy to surgery optimal for rectal cancer in the era of intensity-modulated radiotherapy?: a prospective observational study

Hui Chang, Wu Jiang, Wei-Jun Ye, Ya-Lan Tao, Qiao-Xuan Wang, Wei-Wei Xiao, Yuan-Hong Gao, Hui Chang, Wu Jiang, Wei-Jun Ye, Ya-Lan Tao, Qiao-Xuan Wang, Wei-Wei Xiao, Yuan-Hong Gao

Abstract

Objectives: To evaluate the impact of interval between neoadjuvant chemoradiotherapy (NACRT) and surgery on therapeutic and adverse effects of surgery, and long-term outcome of patients with locally advanced rectal cancer (RC), in the era of intensity-modulated radiotherapy (IMRT).

Patients and methods: Patients diagnosed with stage II-III RC and treated with IMRT-based NACRT followed by radical surgery were enrolled consecutively from April 2011 to March 2014. The data of all the patients were collected prospectively and grouped according to their NACRT-to-surgery interval. The therapeutic and adverse effects of surgery, and survivals were compared between the patients with interval ≤7 weeks and those with interval ≥8 weeks.

Results: A total of 231 patients were eligible for analysis, including 106 cases with interval ≤7 weeks and 125 cases with interval ≥8 weeks. The therapeutic and adverse effects of surgery were similar between these two groups of patients. However, interval ≥8 weeks appeared to lead to poorer overall, distant-metastasis-free and disease-free survivals, compared with interval ≤7 weeks. The HRs were 1.805, 1.714, and 1.796 (P-values were 0.045, 0.049, and 0.028), respectively.

Conclusion: For patients with locally advanced RC, a long NACRT-to-surgery interval might bring a potential risk of increased distant metastasis rather than a better tumor regression in the era of IMRT.

Keywords: interval; neoadjuvant chemoradiotherapy; rectal cancer; surgery; survival.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
The procedure of this study. Abbreviations: RC, rectal cancer; NACRT, neoadjuvant chemoradiotherapy; DM, distant metastasis; IMRT, intensity-modulated radiotherapy; CEA, carcinoembryonic antigen; CA19-9, carbohydrate antigen 19-9.
Figure 2
Figure 2
Down-T, pCR, and sphincter – preserving rates between patients with different intervals from NACRT to surgery. Abbreviations: NACRT, neoadjuvant chemoradiotherapy; pCR, pathological complete remission.
Figure 3
Figure 3
No difference was seen in intraoperative bleeding volume (A), surgery time (B) and hospitalization days (C), between patients with different intervals from neoadjuvant chemoradiotherapy (NACRT) to surgery. Notes:*extreme outliers (> upper quartile + 3 × interquartile range), °mild outliers (> upper quartile + 1.5 × interquartile range). Abbreviation: NACRT, neoadjuvant chemoradiotherapy.
Figure 4
Figure 4
Adjusted survival curves of patients with different intervals from NACRT to surgery. Notes: (A) OS; (B) MFS; (C) DFS. The covariates in the Cox model included CEA, CA19-9, NACRT-to-surgery interval, and pathologic N stage. Abbreviations: OS, overall survival; MFS, distant-metastasis-free survival; DFS, disease-free survival; CEA, carcinoembryonic antigen; CA19-9, carbohydrate antigen 19-9; NACRT, neoadjuvant chemoradiotherapy.

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Source: PubMed

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