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Therapeutic effects and limitations of chemoradiotherapy in advanced lower rectal cancer focusing on T4b

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Abstract

Purpose

This study aimed to elucidate the benefits and limitations of preoperative chemoradiotherapy (CRT) in rectal cancer treatment, specifically in T4b rectal cancer.

Methods

This retrospective cohort study reviewed 1014 consecutive patients with clinical T3/4a/T4b adenocarcinomas of the lower rectum, who underwent total mesorectal excision at the Department of Surgical Oncology of the University of Tokyo Hospital and 22 referral institutions affiliated with the Japanese Study Group for Postoperative Follow-up of Colorectal Cancer. Patients were divided into two cohorts: cohort 1 comprised 298 consecutive patients who underwent CRT followed by radical surgery and cohort 2 comprised 716 consecutive patients who underwent curative surgery without preoperative therapy. We assessed the prognostic differences between the two cohorts, focusing particularly on T stages.

Results

In T3/4a patients, cohort 1 showed a significantly lower local recurrence rate than cohort 2 (4.8% vs. 9.4%, p=0.024), but not in T4b patients (23.5% vs. 16.0%, p=0.383). In contrast, no significant differences in survival were observed between T3/4a and T4b patients. T4b classification was found to be an independent predictive factor of local recurrence in cohort 1, but not in cohort 2.

Conclusion

In T4b rectal cancer, preoperative CRT demonstrated a limited benefit for local control and survival. In cases of suspected T4b rectal tumors, additional therapies such as induction chemotherapy to conventional CRT may contribute to better outcomes.

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Acknowledgements

This study was based on the data obtained from 22 hospitals that are members of the Japanese Study Group for Postoperative Follow-up of CRC. The contributors are Ichiro Takemasa (Sapporo Medical University), Kenichi Hakamada (Hirosaki University), Hitoshi Kameyama (Niigata University), Yasukimi Takii (Niigata Cancer Center Hospital), Hideki Ueno (National Defense Medical College), Heita Ozawa (Tochigi Cancer Center), Soichiro Ishihara (the University of Tokyo), Keiichi Takahashi (Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital), Yukihide Kanemitsu (National Cancer Center Hospital), Michio Itabashi (Tokyo Women’s Medical University), Tomomichi Kiyomatsu (National Center for Global Health and Medicine), Yusuke Kinugasa (Tokyo Medical and Dental University), Takeshi Okabayashi (Keio University), Yojiro Hashiguchi (Teikyo University), Tadahiko Masaki (Kyorin University), Masahiko Watanabe (Kitasato University), Akio Shiomi (Shizuoka Cancer Center), Kouichi Hanai (Fujita Health University), Koji Komori (Aichi Cancer Center Hospital), Yoshiharu Sakai (Kyoto University), Masayuki Ohue (Osaka Medical Center for Cancer and Cardiovascular Diseases), Shingo Noura (Osaka Rosai Hospital), Naohiro Tomita (Hyogo College of Medicine), and Yoshito Akagi (Kurume University).

Funding

This research was supported by Grants-in-Aid for Scientific Research (C: grant number 18K07194; C: grant number 19K09114; C: grant number 19K09115; C: grant number 20K09051; Challenging Research (Exploratory): grant number 20K21626) from the Japan Society for the Promotion of Science. This research was supported by the Project for Cancer Research and Therapeutic Evolution (P-CREATE) (grant number JP 19cm0106502) from the Japan Agency for Medical Research and Development (AMED).

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Authors and Affiliations

  1. Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan

    Kosuke Ozaki, Kazushige Kawai, Hiroaki Nozawa, Kazuhito Sasaki, Koji Murono, Shigenobu Emoto, Yuuki Iida, Hiroaki Ishii, Yuichiro Yokoyama, Hiroyuki Anzai, Hirofumi Sonoda & Soichiro Ishihara

  2. Department of Surgical Oncology, Tokyo Medical and Dental University, Tokyo, Japan

    Kenichi Sugihara

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  1. Kosuke Ozaki
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  2. Kazushige Kawai
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  3. Hiroaki Nozawa
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  4. Kazuhito Sasaki
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  13. Soichiro Ishihara
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Corresponding author

Correspondence to Kosuke Ozaki.

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Ethics approval

This study was approved by the ethics committees of the University of Tokyo Hospital (no. 3252-(10)) and Tokyo Medical and Dental University (no. M2017-268).

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Written informed consent was obtained from all participants in the study.

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The participant has consented to the submission of the case report to the journal.

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The authors declare no competing interests.

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Online Resource 1

Flow chart of the study patient selection in each cohort. CRT, chemoradiotherapy; NAC, neoadjuvant chemotherapy; cT, clinical T stage (PNG 179 kb).

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Ozaki, K., Kawai, K., Nozawa, H. et al. Therapeutic effects and limitations of chemoradiotherapy in advanced lower rectal cancer focusing on T4b. Int J Colorectal Dis 36, 1525–1534 (2021). https://doi.org/10.1007/s00384-021-03936-4

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