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Neoadjuvant chemoradiotherapy for locally advanced rectal cancer with peritumoral abscesses and fistulas

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Abstract

Purpose

Rectal cancer patients who present with peritumoral abscesses and fistulas at the time of diagnosis may be denied chemoradiotherapy (CRT) as the safety is unknown. The aim of this study was to investigate the safety of preoperative CRT in this patient group.

Methods

We performed a retrospective nested case–control study to compare outcomes between patients with locally advanced rectal cancer with peritumoral abscesses and fistulas (study group) and patients with T4 locally advanced rectal cancer with no evidence of abscesses and fistulas (control group). These groups were matched by treatment center and radiotherapy delivery method. All patients received 50–54 Gy of conventionally fractionated RT with concurrent chemotherapy. Primary endpoint was grade 3–5 toxicity (by National Cancer Institute Common Toxicity Criteria for Adverse Events (NCI CTCAE). Secondary endpoints included postoperative morbidity, pathologic complete response (pCR), disease-free survival (DFS), and overall survival (OS) at 2 years.

Results

A total of 33 patients were included in each group. Grade 3 toxicity was observed in 2 (6.1%) patients in the study group and 4 (12.1%) patients in the control group (p = 0.672). No patients developed grade 4–5 toxicity. Grade 3–4 Clavien–Dindo complications were observed in 5 (15.2%) patients in the study group and in 6 (18.2%) patients in the control group (p = 1.0). Pathologic CR was achieved in 3 (9.1%) and 5 (15.2%) patients, respectively (p = 0.708). Two-year OS was 78.3% vs. 81.8% (p = 0.944), 2‑year DFS was 62.8% vs. 69.7% (p = 0.693), respectively.

Conclusion

The presence of peritumoral abscesses and fistulas in patients with locally advanced rectal cancer is not associated with increased toxicity or inferior clinical outcomes after preoperative CRT.

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References

  1. Cameron MG, Kersten C, Vistad I, van Helvoirt R, Weyde K, Undseth C, Mjaaland I, Skovlund E, Fossa SD, Guren MG (2016) Palliative pelvic radiotherapy for symptomatic rectal cancer—a prospective multicenter study. Acta Oncol 55(12):1400–1407. https://doi.org/10.1080/0284186X.2016.1191666

    Article  CAS  PubMed  Google Scholar 

  2. Bacalbasa N, Bãlescu I (2015) Total pelvic exenteration for locally invasive cervical cancer with vesico-vaginal fistula. Mod Med 22(1):73–77

    Google Scholar 

  3. Matsumoto T, Nakanishi M, Miyamae M, Takao K, Fukunaga T, Otsuji E (2017) A case of locally advanced rectal cancer with abscess and rectovesical fistula curatively resected following preoperative chemotherapy. Gan To Kagaku Ryoho 44(12):1482–1484

    PubMed  Google Scholar 

  4. el Benjelloun B, Aitalalim S, Chbani L, Mellouki I, Mazaz K, Aittaleb K (2012) Rectosigmoid adenocarcinoma revealed by metastatic anal fistula. The visible part of the iceberg: a report of two cases with literature review. World J Surg Oncol 10:209. https://doi.org/10.1186/1477-7819-10-209

    Article  PubMed Central  Google Scholar 

  5. Kitahara T, Uemura M, Haraguchi N, Nishimura J, Shingai T, Hata T, Takemasa I, Mizushima T, Doki Y, Mori M, Yamamoto H (2014) Successful treatment of rectal cancer with perineal invasion: three case reports. mol clin onc 2(4):497–500. https://doi.org/10.3892/mco.2014.282

    Article  Google Scholar 

  6. Mitrushi A, Bilali S, Bilali V, Mitrushi F, Mehmeti E (2017) A clinical case of perineal invasion from rectal carcinoma. G Chir 38(4):199–201

    Article  CAS  Google Scholar 

  7. Miyakawa T, Iida S, Igaki T, Shiobara H, Matsumoto R, Mitachi K, Ohata Y, Saito K, Miura T, Irie T, Yamazaki S (2017) Neoadjuvant chemoradiotherapy for locally advanced carcinoma associated with anal fistula. Gan To Kagaku Ryoho 44(12):1437–1439

    PubMed  Google Scholar 

  8. Kuroda M, Ikeda E, Yokoyama N, Kenmotsu M, Takagi S, Yamano T (2016) A case of carcinoma associated with an anal fistula repaired using a hatchet flap after neoadjuvant chemoradiotherapy. Gan To Kagaku Ryoho 43(12):1650–1652

    PubMed  Google Scholar 

  9. Morikawa T, Yamashita K, Sumi Y, Kanemitsu K, Yamamoto M, Kanaji S, Imanishi T, Nakamura T, Suzuki S, Tanaka K, Kakeji Y (2014) Laparoscopic abdominoperineal resection after preoperative chemoradiotherapy for advanced carcinoma associated with anal fistula. Gan To Kagaku Ryoho 41(12):1875–1877

    PubMed  Google Scholar 

  10. Ishigame T, Momma T, Suzuki S, Nakamura I, Ohki S, Koyama Y, Takenoshita S (2012) A case of carcinoma associated with anal fistula in which reconstruction using a gracilis musculocutaneous flap was performed after preoperative chemoradiotherapy. Gan To Kagaku Ryoho 39(12):1957–1959

    PubMed  Google Scholar 

  11. Yaegashi M, Otsuka K, Kimura T, Matsuo T, Sato K, Takashimizu K, Hatanaka T, Yoshida T, Tono C, Minagawa Y (2017) A case of more than five-year survival of carcinoma associated with anal fistula effectively treated by combined modality therapy. Gan To Kagaku Ryoho 44(12):1754–1756

    PubMed  Google Scholar 

  12. Zhan T, Wang L, Li M, Li Z, Cai Y, Shen L, Gu J (2012) A multidisciplinary clinical treatment of locally advanced rectal cancer complicated with rectovesical fistula: a case report. J Med Case Reports 6:369. https://doi.org/10.1186/1752-1947-6-369

    Article  Google Scholar 

  13. Schwartz LH, Litière S, de Vries E, Ford R, Gwyther S, Mandrekar S, Shankar L, Bogaerts J, Chen A, Dancey J (2016) RECIST 1.1—Update and clarification: from the RECIST committee. Eur J Cancer 62:132–137

    Article  Google Scholar 

  14. Kuwabara H, Watanabe S, Liu B, Mitsuoka A, Sanada T, Nakajima K, Goseki N (2013) A case of locally advanced colorectal cancer with abscess responding to 5‑fluorouracil, leucovorin, and oxaliplatin plus bevacizumab. Gan To Kagaku Ryoho 40(12):2032–2034

    PubMed  Google Scholar 

  15. Nakayasu Y, Yoshimatsu K, Yokomizo H, Osawa G, Yano Y, Nakayama M, Sakuma A, Yamaguchi K, Shiozawa S, Shimakawa T, Katsube T, Naritaka Y (2013) Two cases of locally advanced colorectal cancer curatively resected after neoadjuvant chemotherapy with 5‑fluorouracil, leucovorin, and oxaliplatin plus panitumumab. Gan To Kagaku Ryoho 40(12):2029–2031

    PubMed  Google Scholar 

  16. Murata A, Takatsuka S, Shinkawa H, Kaizaki R, Hori T, Ikehara T (2014) A case report of metastatic anal fistula cancer treated with neoadjuvant chemotherapy. Gan To Kagaku Ryoho 41(12):1869–1871

    PubMed  Google Scholar 

  17. Nushijima Y, Nakano K, Sugimoto K, Nakaguchi K, Kan K, Maruyama H, Doi S, Okamura S, Murata K (2014) A case of primary carcinoma associated with anal fistula. Gan To Kagaku Ryoho 41(12):1872–1874

    PubMed  Google Scholar 

  18. Cui J, Fang H, Zhang L, Wu YL, Zhang HZ (2016) Advances for achieving a pathological complete response for rectal cancer after neoadjuvant therapy. Chronic Dis Transl Med 2(1):10–16. https://doi.org/10.1016/j.cdtm.2016.06.001

    Article  PubMed  PubMed Central  Google Scholar 

  19. Pechlivanides G, Gourtsoyianni S, Gouvas N, Sougklakos J, Xynos E (2021) Management of the adenocarcinoma of the upper rectum: a reappraisal. Updates Surg 73(2):513–526. https://doi.org/10.1007/s13304-020-00903-6

    Article  PubMed  Google Scholar 

  20. Van Wickle JD, Paulson ES, Landry JC, Erickson BA, Hall WA (2017) Adaptive radiation dose escalation in rectal adenocarcinoma: a review. J Gastrointest Oncol 8(5):902–914. https://doi.org/10.21037/jgo.2017.07.06

    Article  PubMed  PubMed Central  Google Scholar 

  21. Caravatta L, Lupattelli M, Mantello G, Gambacorta MA, Chiloiro G, di Tommaso M, Rosa C, Gasparini L, Morganti AG, Picardi V, Niespolo RM, Osti MF, Montrone S, Simoni N, Boso C, Facchin F, Deidda MA, Piva C, Guida C, Ziccarelli L, Munoz F, Ivaldi GB, Marchetti V, Franzone P, Spatola C, Franco P, Donato V, Genovesi D, Gastrointestinal Study Group of A (2021) Treatment volume, dose prescription and delivery techniques for dose-intensification in rectal cancer: a national survey. Anticancer Res 41(4):1985–1995. https://doi.org/10.21873/anticanres.14966

    Article  CAS  PubMed  Google Scholar 

  22. Sun Z, Adam MA, Kim J, Czito B, Mantyh C, Migaly J (2017) Intensity-modulated radiation therapy is not associated with perioperative or survival benefit over 3D-conformal radiotherapy for rectal cancer. J Gastrointest Surg 21(1):106–111

    Article  Google Scholar 

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Funding

This work was supported by the N.N. Blokhin Russian Cancer Research Center

Author information

Authors and Affiliations

  1. N.N.Blokhin National Medical Research Center of Oncology, 23, Kashirskoe shosse, 115478, Moscow, Russian Federation

    Sergey Gordeyev, Mikhail Fedianin, Marina Chernikh, Nikolay Kozlov & Zaman Mamedli

  2. “PET-technology” cancer center, 26, 50 let VLKSM st., 142110, Podolsk, Russian Federation

    Valerii Ivanov & Marina Chernikh

  3. I.M.Sechenov First Moscow State Medical University, Moscow, Russian Federation

    Marina Chernikh

  4. A.F. Tsyb Medical Radiological Research Center, Zhukov st., 249031, Obninsk, Russian Federation

    Leonid Petrov

  5. Moscow city oncological hospital № 1, Baumanskaya 17/1, 105005, Moscow, Russian Federation

    Dmitriy Erygin

  6. Stavropol regional oncological dispensary, 182A, Oktyabrskaya st., 355047, Stavropol, Russian Federation

    Ivan Gridasov

  7. Krasnodar regional oncological dispensary, 146, Dmitrova st., 350040, Krasnodar, Russian Federation

    Valery Kaushanskiy

  8. Bashkir regional oncological dispensary, 73/1, Prospekt Octyabrya, 450054, Ufa, Russian Federation

    Dmitry Feoktistov

  9. Department of oncology and hematology at medical faculty of the Peoples’ Friendship University of Russia (RUDN University), Moscow, Russian Federation

    Mikhail Fedianin

Authors
  1. Sergey Gordeyev
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  2. Valerii Ivanov
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  3. Mikhail Fedianin
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  4. Marina Chernikh
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  5. Nikolay Kozlov
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  6. Leonid Petrov
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  7. Dmitriy Erygin
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  8. Ivan Gridasov
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  9. Valery Kaushanskiy
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  10. Dmitry Feoktistov
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  11. Zaman Mamedli
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Contributions

All authors contributed to the conception of the work, analysis, and data interpretation. All authors have revised the manuscript critically and approved the version to be published.

Corresponding author

Correspondence to Sergey Gordeyev.

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Conflict of interest

S. Gordeyev, V. Ivanov, M. Fedianin, M. Chernikh, N. Kozlov, L. Petrov, D. Erygin, I. Gridasov, V. Kaushanskiy, D. Feoktistov, and Z. Mamedli declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Ethical approval was waived by the local Ethics Committee of N.N. Blokhin Russian Cancer Research Center in view of the retrospective nature of the study and all the procedures being performed were part of the routine care. Consent to participate: Written informed consent was obtained from all patients. Consent for publication: No personal data or images are presented in this article.

Additional information

Availability of data and material

The datasets generated during the current study are available from the corresponding author on reasonable request. The dataset is available at the repository of the Russian Colorectal Cancer Society (db.oncoproct.ru).

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Gordeyev, S., Ivanov, V., Fedianin, M. et al. Neoadjuvant chemoradiotherapy for locally advanced rectal cancer with peritumoral abscesses and fistulas. Strahlenther Onkol 198, 201–208 (2022). https://doi.org/10.1007/s00066-021-01878-y

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  • DOI: https://doi.org/10.1007/s00066-021-01878-y

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