International Journal of Colorectal Disease

, Volume 30, Issue 9, pp 1193–1199 | Cite as

Comparison of oncologic outcomes of metastatic rectal cancer patients with or without neoadjuvant chemoradiotherapy

Original Article

Abstract

Purpose

The aim of this study is to evaluate the effect of neoadjuvant chemoradiotherapy in stage IV rectal cancer.

Methods

Primary rectal cancer patients with synchronous distant metastases between September 2001 and August 2011 were enrolled. Of 86 patients, 40 patients underwent neoadjuvant chemoradiotherapy (RTX group) and the remaining 46 patients underwent postoperative systemic chemotherapy without radiotherapy (NRTX group). Sharp mesorectal excision according to tumor location was performed. Oncologic outcomes were compared.

Results

The lower tumor location was more common in RTX group than NRTX group (60.0 vs. 28.3 %, P = 0.003). Clinical T and N status and American Society of Anesthesiologist (ASA) score were similar in both groups. The incidence of pathologic LN metastases in the NRTX group was 93.5 % compared with 70.0 % in RTX group (P = 0.007). Pattern of distant metastasis was similar between groups. However, metastatectomy was frequently performed in RTX group than NRTX group (57.5 vs. 30.4 %, P = 0.020). There was no statistical difference in local recurrence rate between groups (10.0 % in RTX vs. 15.2 % in NRTX, P = 0.470). The median PFS was similar in both groups (12.00 months in RTX vs. 12.00 months in NRTX, P = 0.768). The median OS between groups was also not different (24.00 months in RTX vs. 27.00 months in NRT, P = 0.510).

Conclusions

Neoadjuvant chemoradiotherapy may not affect local control and overall survival in locally advanced rectal cancer with distant metastasis.

Keywords

Rectal neoplasms Neoadjuvant chemoradiotherapy Metastases Stage IV 

References

  1. 1.
    Kopetz S, Chang GJ, Overman MJ, Eng C, Sargent DJ, Larson DW, Grothey A, Vauthey J-N, Nagorney DM, McWilliams RR (2009) Improved survival in metastatic colorectal cancer is associated with adoption of hepatic resection and improved chemotherapy. J Clin Oncol 27(22):3677–3683PubMedCentralCrossRefPubMedGoogle Scholar
  2. 2.
    Adam R, Delvart V, Pascal G, Valeanu A, Castaing D, Azoulay D, Giacchetti S, Paule B, Kunstlinger F, Ghémard O (2004) Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg 240(4):644PubMedCentralPubMedGoogle Scholar
  3. 3.
    Van Cutsem E, Lang I, D’haens G, Moiseyenko V, Zaluski J, Folprecht G, Tejpar S, Kisker O, Stroh C, Rougier P (2008) KRAS status and efficacy in the first-line treatment of patients with metastatic colorectal cancer (mCRC) treated with FOLFIRI with or without cetuximab: the crystal experience. J Clin Oncol 26(15 suppl):2Google Scholar
  4. 4.
    Rees M, Tekkis PP, Welsh FK, O’Rourke T, John TG (2008) Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer: a multifactorial model of 929 patients. Ann Surg 247(1):125–135CrossRefPubMedGoogle Scholar
  5. 5.
    Ardito F, Vellone M, Cassano A, De Rose AM, Pozzo C, Coppola A, Federico B, Giovannini I, Barone C, Nuzzo G (2013) Chance of cure following liver resection for initially unresectable colorectal metastases: analysis of actual 5-year survival. J Gastrointest Surg 17(2):352–359CrossRefPubMedGoogle Scholar
  6. 6.
    National Comprehensive Cancer Network I (2014) NCCN clinical practice guidelines in oncology version 3.2014Google Scholar
  7. 7.
    Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, Martus P, Tschmelitsch J, Hager E, Hess CF (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351(17):1731–1740CrossRefPubMedGoogle Scholar
  8. 8.
    Frykholm GJ, Glimelius B, Påhlman L (1993) Preoperative or postoperative irradiation in adenocarcinoma of the rectum: final treatment results of a randomized trial and an evaluation of late secondary effects. Dis Colon Rectum 36(6):564–572CrossRefPubMedGoogle Scholar
  9. 9.
    Gérard A, Buyse M, Nordlinger B, Loygue J, Pène F, Kempf P, Bosset JF, Gignoux M, Arnaud JP, Desaive C (1988) Preoperative radiotherapy as adjuvant treatment in rectal cancer. Final results of a randomized study of the European Organization for Research and Treatment of Cancer (EORTC). Ann Surg 208(5):606PubMedCentralCrossRefPubMedGoogle Scholar
  10. 10.
    Group CCC (2001) Adjuvant radiotherapy for rectal cancer: a systematic overview of 8,507 patients from 22 randomised trials. Lancet 358(9290):1291–1304. doi:10.1016/s0140-6736(01)06409-1 CrossRefGoogle Scholar
  11. 11.
    Chang CY, Kim HC, Park YS, Park JO, Choi DH, Park HC, Cho YB, Yun SH, Lee WY, Chun HK (2012) The effect of postoperative pelvic irradiation after complete resection of metastatic rectal cancer. J Surg Oncol 105(3):244–248. doi:10.1002/jso.22109 CrossRefPubMedGoogle Scholar
  12. 12.
    Lee JH, Jo IY, Yoon SC, Kim YS, Choi BO, Kim JG, Oh ST, Lee MA, Jang HS (2012) The role of postoperative pelvic radiation in stage IV rectal cancer after resection of primary tumor. Radiat Oncol J 30(4):205–212. doi:10.3857/roj.2012.30.4.205 PubMedCentralCrossRefPubMedGoogle Scholar
  13. 13.
    Cammà C, Giunta M, Fiorica F, Pagliaro L, Craxì A, Cottone M (2000) Preoperative radiotherapy for resectable rectal cancer: a meta-analysis. JAMA 284(8):1008–1015CrossRefPubMedGoogle Scholar
  14. 14.
    Guillem JG, Chessin DB, Cohen AM, Shia J, Mazumdar M, Enker W, Paty PB, Weiser MR, Klimstra D, Saltz L (2005) Long-term oncologic outcome following preoperative combined modality therapy and total mesorectal excision of locally advanced rectal cancer. Ann Surg 241(5):829PubMedCentralCrossRefPubMedGoogle Scholar
  15. 15.
    Valentini V, Coco C, Picciocchi A, Morganti AG, Trodella L, Ciabattoni A, Cellini F, Barbaro B, Cogliandolo S, Nuzzo G (2002) Does downstaging predict improved outcome after preoperative chemoradiation for extraperitoneal locally advanced rectal cancer? A long-term analysis of 165 patients. Int J Radiat Oncol Biol Phys 53(3):664–674CrossRefPubMedGoogle Scholar
  16. 16.
    Theodoropoulos G, Wise W, Padmanabhan A, Kerner B, Taylor C, Aguilar P, Khanduja K (2002) T-level downstaging and complete pathologic response after preoperative chemoradiation for advanced rectal cancer result in decreased recurrence and improved disease-free survival. Dis Colon Rectum 45(7):895–903CrossRefPubMedGoogle Scholar
  17. 17.
    Minsky BD, Cohen AM, Kemeny N, Enker WE, Kelsen DP, Reichman B, Saltz L, Sigurdson ER, Frankel J (1992) Enhancement of radiation-induced downstaging of rectal cancer by fluorouracil and high-dose leucovorin chemotherapy. J Clin Oncol 10(1):79–84PubMedGoogle Scholar
  18. 18.
    Das P, Skibber JM, Rodriguez Bigas MA, Feig BW, Chang GJ, Wolff RA, Eng C, Krishnan S, Janjan NA, Crane CH (2007) Predictors of tumor response and downstaging in patients who receive preoperative chemoradiation for rectal cancer. Cancer 109(9):1750–1755CrossRefPubMedGoogle Scholar
  19. 19.
    Gérard J-P, Azria D, Gourgou-Bourgade S, Martel-Laffay I, Hennequin C, Etienne P-L, Vendrely V, François E, de La Roche G, Bouché O (2010) Comparison of two neoadjuvant chemoradiotherapy regimens for locally advanced rectal cancer: results of the phase III trial ACCORD 12/0405-Prodige 2. J Clin Oncol 28(10):1638–1644CrossRefPubMedGoogle Scholar
  20. 20.
    Pahlman L, Glimelius B (1997) Improved survival with preoperative radiotherapy in resectable rectal cancer. New Engl J Med 336:980CrossRefGoogle Scholar
  21. 21.
    Galizia G, Lieto E, Orditura M, Castellano P, Imperatore V, Pinto M, Zamboli A (2008) First-line chemotherapy vs bowel tumor resection plus chemotherapy for patients with unresectable synchronous colorectal hepatic metastases. Arch Surg 143(4):352–358CrossRefPubMedGoogle Scholar
  22. 22.
    Nash GM, Saltz LB, Kemeny NE, Minsky B, Sharma S, Schwartz GK, Ilson DH, O’Reilly E, Kelsen DP, Nathanson DR (2002) Radical resection of rectal cancer primary tumor provides effective local therapy in patients with stage IV disease. Ann Surg Oncol 9(10):954–960CrossRefPubMedGoogle Scholar
  23. 23.
    Kusters M, Marijnen CA, van de Velde CJ, Rutten HJ, Lahaye MJ, Kim JH, Beets-Tan RG, Beets GL (2010) Patterns of local recurrence in rectal cancer; a study of the Dutch TME trial. Eur J Surg Oncol (EJSO) 36(5):470–476CrossRefGoogle Scholar
  24. 24.
    Lin JK, Lee LK, Chen WS, Lin TC, Jiang JK, Yang SH, Wang HS, Chang SC, Lan YT, Lin CC, Yen CC, Liu JH, Tzeng CH, Teng HW (2012) Concurrent chemoradiotherapy followed by metastasectomy converts to survival benefit in stage IV rectum cancer. J Gastrointest Surg 16(10):1888–1896. doi:10.1007/s11605-012-1959-6 CrossRefPubMedGoogle Scholar
  25. 25.
    Masuda T, Ishikawa T, Iwata N, Baba H, Takahashi H, Okazaki S, Matsuyama T, Ishiguro M, Kobayashi H, Iida S (2013) A case of advanced rectal cancer with bone metastasis successfully treated with chemo-radiation therapy. Gan Kagaku Ryoho Cancer Chemother 40(12):1999–2001Google Scholar
  26. 26.
    Kanoh T, Ohnishi T, Danno K, Watanabe A, Nakamura H, Tsukao Y, Inatome J, Kim C, Kagara N, Taniguchi H (2010) A case of successfully treated lower rectal cancer with both inguinal lymph nodes by chemoradiotherapy. Gan Kagaku Ryoho Cancer Chemother 37(12):2611–2613Google Scholar
  27. 27.
    Amano M, Niinobu T, Nishikawa Y, Yamashita S, Nakagawa S, Higaki N, Hayashida H, Yoshioka Y, Fujita M, Sakon M (2006) A case report of successful local control with chemoradiation for unresectable rectal cancer. Gan Kagaku Ryoho Cancer Chemother 33(12):1980–1982Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  1. 1.Department of Surgery, College of MedicineYeungnam UniversityDaeguSouth Korea

Personalised recommendations