6533b7d1fe1ef96bd125c46a
RESEARCH PRODUCT
Trends and outcome of neoadjuvant treatment for rectal cancer: A retrospective analysis and critical assessment of a 10-year prospective national registry on behalf of the Spanish Rectal Cancer Project
Gianluca PellinoRafael AlósSebastiano BiondoAntonio Codina-cazadorJosé María Enríquez-navascuesEloy Espín-basanyJosé Vicente Roig-vilaAndrés CervantesEduardo García-graneroRaúl Adell CarcellerJuan Guillermo Ais CondeEvelio Alonso AlonsoAntonio Amaya CortijoAntonio Arroyo SebastianPedro Barra BañosRicard Batlle SoléJuan C. Bernal SprekelsenSebastiano BiondoFrancisco J. Blanco GonzalezSantiago BlancoJ. BolloNieves Cáceres AlvaradoIgnasi Camps AusasRamon Cantero CidJosé Antonio Carmona SaezEnrique Casal NuñezLuis Cristobal Capitán MoralesGuillermo Carreño VillarrealJesús Cifuentes TebarMiguel Á. Ciga LozanoAntonio Codina CazadorJuan De Dios Franco OsorioMaría De La Vega OlíasMario De Miguel VelascoSergio Rodrigo Del ValleJosé G. Díaz MejíasJosé M. Díaz PavónJavier Die TrillJosé L. Dominguez TristanchoPaula Dujovne LindenbaumJosé Errasti AlustizaAlejandro Espí MaciasEloy Espín BasanyRafael Estévan EstévanAlfredo M. Estevez DizLuis FloresDomenico FraccalvieriAlessandro GarceaMauricio García AlonsoMiguel Garcia BotellaMaria José García CoretAlfonso García FadriqueJosé M. García GarcíaJacinto García GarcíaEduardo García-graneroJesús Á. Garijo AlvarezJosé Gomez BarbadilloFernando GrisVerónica GumbauJavier GutierrezPilar Hernandez CasanovasDaniel Huerga AlvarezAna M. Huidobro PirizFrancisco Javier Jimenez MiramónAna Lage LaredoAlberto Lamiquiz VallejoFélix Lluis CasajuanaManuel López LaraJuan A. Lujan MompeanMaría Victoria MaestreEva Martí MartínezM. MartinezJavier Martinez AlegreGabriel Martínez GallegoRoberto Martinez PardavilaOlga Maseda DíazMónica Millan SchedlingBenito MirónJosé Monzón AbadJosé A. Múgica MartineraFrancisco Olivet PujolMónica Orelogio OrozcoLuis Ortiz De ZarateRosana Palasí GimenezNatividad Palencia GarcíaPablo Palma CarazoAlberto Parajo CalvoJesús Paredes CotoreCarlos Pastor IdoateMiguel Pera RomanFrancisco Pérez BenítezJosé A. Pérez GarcíaMarta Piñol PascualIsabel Prieto NietoRicardo Rada MorgadesMónica Reig PérezÁNgel Reina DuarteDidac Ribé SerratXavier RodamilansMaría D. Ruiz CarmonaMarcos Rodriguez MartinFrancisco Romero AceitunoJesús Salas MartínezGinés Sánchez De La VillaInmaculada Segura JimenezJosé Enrique Sierra GrañonAmparo Solana BuenoAlbert Sueiras GilTeresa Torres SanchezNatalia Uribe QuintanaJavier Valdés HernándezFancesc VallriberaVicent Viciano Pascualsubject
MaleSurvivalColorectal cancermedicine.medical_treatmentT stage030230 surgeryTNM0302 clinical medicineRegistriesStage (cooking)Rectal cancerAged 80 and overMargins of ExcisionGeneral MedicineMiddle AgedNeoadjuvant TherapySurvival Ratemedicine.anatomical_structureTreatment OutcomeOncology030220 oncology & carcinogenesisFemaleAdultmedicine.medical_specialtyNeoadjuvant treatmentPrognosiRectum03 medical and health sciencesYoung AdultmedicineAdjuvant therapyHumansChemotherapyAgedNeoplasm StagingRetrospective StudiesChemotherapyRadiotherapybusiness.industryRectal NeoplasmsCancerChemoradiotherapy Adjuvantmedicine.diseaseSurgeryRadiation therapySpainT-stageSurgerybusinessFollow-Up StudiesForecastingdescription
Introduction: Preoperative treatment and adequate surgery increase local control in rectal cancer. However, modalities and indications for neoadjuvant treatment may be controversial. Aim of this study was to assess the trends of preoperative treatment and outcomes in patients with rectal cancer included in the Rectal Cancer Registry of the Spanish Associations of Surgeons. Method: This is a STROBE-compliant retrospective analysis of a prospective database. All patients operated on with curative intention included in the Rectal Cancer Registry were included. Analyses were performed to compare the use of neoadjuvant/adjuvant treatment in three timeframes: I)2006–2009; II)2010–2013; III)2014–2017. Survival analyses were run for 3-year survival in timeframes I-II. Results: Out of 14, 391 patients, 8871 (61.6%) received neoadjuvant treatment. Long-course chemo/radiotherapy was the most used approach (79.9%), followed by short-course radiotherapy ± chemotherapy (7.6%). The use of neoadjuvant treatment for cancer of the upper third (15-11 cm) increased over time (31.5%vs 34.5%vs 38.6%, p = 0.0018). The complete regression rate slightly increased over time (15.6% vs 16% vs 18.5%; p = 0.0093); the proportion of patients with involved circumferential resection margins (CRM) went down from 8.2% to 7.3%and 5.5% (p = 0.0004). Neoadjuvant treatment significantly decreased positive CRM in lower third tumors (OR 0.71, 0.59–0.87, Cochrane-Mantel-Haenszel P = 0.0008). Most ypN0 patients also received adjuvant therapy. In MR-defined stage III patients, preoperative treatment was associated with significantly longer local-recurrence-free survival (p < 0.0001), and cancer-specific survival (p < 0.0001). The survival benefit was smaller in upper third cancers. Conclusion: There was an increasing trend and a potential overuse of neoadjuvant treatment in cancer of the upper rectum. Most ypN0 patients received postoperative treatment. Involvement of CRM in lower third tumors was reduced after neoadjuvant treatment. Stage III and MRcN + benefited the most.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2021-01-01 |