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Planned Short-Course Radiation (scRT) is Superior to Upfront Concurrent Chemoradiation (CCRT) in Treating Metastatic Rectal Cancer

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background or Purpose

To compare the cost-performance between planned short-course radiation and upfront concurrent chemoradiation on metastatic rectal cancer.

Methods

A total of 75 patients with metastatic rectal cancer who underwent planned short-course radiation or upfront concurrent chemoradiation were enrolled. The Kaplan-Meier method was used to compute the survival rates. The χ2 test was used to compare baseline characteristics. The Cox proportional hazards model was applied to determine the prognostic influence of clinicopathological factors.

Results

The planned short-course radiation is superior to upfront concurrent chemoradiation in overall survival for the patients with metastatic rectal cancer (34.8 vs. 20.2 months, P = 0.010). The planned short-course radiation was an independent prognostic factor (P = 0.009, HR (95% CI) = 0.319(0.135–0.752)). The efficacy of radiation on downstaging was similar between planned short-course radiation and upfront concurrent chemoradiation. The total cost of concurrent chemoradiation is 4.52-fold more expensive than that of short-course radiation (340,142 vs. 75,106 NT dollars, respectively).

Conclusions

Based on the impressive cost-performance of planned short-course radiation compared with upfront concurrent chemoradiation (better OS, modest downstaging and lower cost), planned short-course radiation should be the preferred radiation approach for managing metastatic rectal cancer.

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References

  1. Naishadham D, Lansdorp-Vogelaar I, Siegel R et al. State disparities in colorectal cancer mortality patterns in the United States. Cancer Epidemiol Biomarkers Prev 2011; 20: 1296–1302

    Article  Google Scholar 

  2. Cunningham D, Humblet Y, Siena S et al. Cetuximab monotherapy and cetuximab plus irinotecan in irinotecan-refractory metastatic colorectal cancer. N Engl J Med 2004; 351: 337–345

    Article  CAS  Google Scholar 

  3. Falcone A, Ricci S, Brunetti I et al. Phase III trial of infusional fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI) compared with infusional fluorouracil, leucovorin, and irinotecan (FOLFIRI) as first-line treatment for metastatic colorectal cancer: the Gruppo Oncologico Nord Ovest. J Clin Oncol 2007; 25: 1670–1676

    Article  CAS  Google Scholar 

  4. Montagnani F, Chiriatti A, Turrisi G et al. A systematic review of FOLFOXIRI chemotherapy for the first-line treatment of metastatic colorectal cancer: improved efficacy at the cost of increased toxicity. Colorectal Dis 2011; 13: 846–852

    Article  CAS  Google Scholar 

  5. Saltz LB, Clarke S, Diaz-Rubio E et al. Bevacizumab in combination with oxaliplatin-based chemotherapy as first-line therapy in metastatic colorectal cancer: a randomized phase III study. J Clin Oncol 2008; 26: 2013–2019

    Article  CAS  Google Scholar 

  6. Souglakos J, Androulakis N, Syrigos K et al. FOLFOXIRI (folinic acid, 5-fluorouracil, oxaliplatin and irinotecan) vs FOLFIRI (folinic acid, 5-fluorouracil and irinotecan) as first-line treatment in metastatic colorectal cancer (MCC): a multicentre randomised phase III trial from the Hellenic Oncology Research Group (HORG). Br J Cancer 2006; 94: 798–805

    Article  CAS  Google Scholar 

  7. Teng HW, Huang YC, Lin JK et al. BRAF mutation is a prognostic biomarker for colorectal liver metastasectomy. Journal of surgical oncology 2012; 106: 123–129

    Article  CAS  Google Scholar 

  8. Lin JK, Lee LK, Chen WS et al. Concurrent chemoradiotherapy followed by metastasectomy converts to survival benefit in stage IV rectum cancer. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 2012; 16: 1888–1896

    Article  Google Scholar 

  9. Hsu YN, Lin JK, Chen WS et al. A new classification scheme for recurrent or metastatic colon cancer after liver metastasectomy. Journal of the Chinese Medical Association : JCMA 2011; 74: 493–499

    Article  Google Scholar 

  10. Van Cutsem E, Nordlinger B, Adam R et al. Towards a pan-European consensus on the treatment of patients with colorectal liver metastases. European journal of cancer 2006; 42: 2212–2221

    Article  Google Scholar 

  11. Choti MA, Sitzmann JV, Tiburi MF et al. Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg 2002; 235: 759–766

    Article  Google Scholar 

  12. Bosset JF, Collette L, Calais G et al. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 2006; 355: 1114–1123

    Article  CAS  Google Scholar 

  13. Bujko K, Nowacki MP, Nasierowska-Guttmejer A et al. Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg 2006; 93: 1215–1223

    Article  CAS  Google Scholar 

  14. Gerard JP, Conroy T, Bonnetain F et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol 2006; 24: 4620–4625

    Article  Google Scholar 

  15. Radu C, Berglund A, Pahlman L et al. Short-course preoperative radiotherapy with delayed surgery in rectal cancer - a retrospective study. Radiother Oncol 2008; 87: 343–349

    Article  Google Scholar 

  16. Ceelen W, Fierens K, Van Nieuwenhove Y et al. Preoperative chemoradiation versus radiation alone for stage II and III resectable rectal cancer: a systematic review and meta-analysis. International journal of cancer Journal international du cancer 2009; 124: 2966–2972

    Article  CAS  Google Scholar 

  17. Shin SJ, Yoon HI, Kim NK et al. Upfront systemic chemotherapy and preoperative short-course radiotherapy with delayed surgery for locally advanced rectal cancer with distant metastases. Radiat Oncol 2011; 6: 99

    Article  Google Scholar 

  18. Kim KH, Shin SJ, Cho MS et al. A phase II study of preoperative mFOLFOX6 with short-course radiotherapy in patients with locally advanced rectal cancer and liver-only metastasis. Radiother Oncol 2016; 118: 369–374

    Article  CAS  Google Scholar 

  19. Picardi V, Deodato F, Guido A et al. Palliative Short-Course Radiation Therapy in Rectal Cancer: A Phase 2 Study. Int J Radiat Oncol Biol Phys 2016; 95: 1184–1190

    Article  Google Scholar 

  20. Bisschop C, van Dijk TH, Beukema JC et al. Short-Course Radiotherapy Followed by Neoadjuvant Bevacizumab, Capecitabine, and Oxaliplatin and Subsequent Radical Treatment in Primary Stage IV Rectal Cancer: Long-Term Results of a Phase II Study. Ann Surg Oncol 2017; 24: 2632–2638

    Article  CAS  Google Scholar 

  21. Holliday EB, Hunt A, You YN et al. Short course radiation as a component of definitive multidisciplinary treatment for select patients with metastatic rectal adenocarcinoma. J Gastrointest Oncol 2017; 8: 990–997

    Article  Google Scholar 

  22. Goodman KA, Milgrom SA, Herman JM et al. ACR Appropriateness Criteria(R) rectal cancer: metastatic disease at presentation. Oncology (Williston Park) 2014; 28: 867–871, 876, 878

    Google Scholar 

  23. Lutz MP, Zalcberg JR, Glynne-Jones R et al. Second St. Gallen European Organisation for Research and Treatment of Cancer Gastrointestinal Cancer Conference: consensus recommendations on controversial issues in the primary treatment of rectal cancer. European journal of cancer 2016; 63: 11–24

    Article  Google Scholar 

  24. Sauer R, Becker H, Hohenberger W et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004; 351: 1731–1740

    Article  CAS  Google Scholar 

  25. Fernandez-Martos C, Pericay C, Aparicio J et al. Phase II, randomized study of concomitant chemoradiotherapy followed by surgery and adjuvant capecitabine plus oxaliplatin (CAPOX) compared with induction CAPOX followed by concomitant chemoradiotherapy and surgery in magnetic resonance imaging-defined, locally advanced rectal cancer: Grupo cancer de recto 3 study. J Clin Oncol 2010; 28: 859–865

    Article  CAS  Google Scholar 

  26. Viani GA, Stefano EJ, Soares FV et al. Evaluation of biologic effective dose and schedule of fractionation for preoperative radiotherapy for rectal cancer: meta-analyses and meta-regression. Int J Radiat Oncol Biol Phys 2011; 80: 985–991

    Article  Google Scholar 

  27. Kapiteijn E, Marijnen CA, Nagtegaal ID et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001; 345: 638–646

    Article  CAS  Google Scholar 

  28. Madoff RD. Chemoradiotherapy for rectal cancer--when, why, and how? N Engl J Med 2004; 351: 1790–1792

    Article  CAS  Google Scholar 

  29. Cady B. Basic principles in surgical oncology. Arch Surg 1997; 132: 338–346

    Article  CAS  Google Scholar 

  30. Bartlett DL, Berlin J, Lauwers GY et al. Chemotherapy and regional therapy of hepatic colorectal metastases: expert consensus statement. Ann Surg Oncol 2006; 13: 1284–1292

    Article  Google Scholar 

  31. Minsky BD. Counterpoint: long-course chemoradiation is preferable in the neoadjuvant treatment of rectal cancer. Semin Radiat Oncol 2011; 21: 228–233

    Article  Google Scholar 

  32. Bujko K, Bujko M. Point: short-course radiation therapy is preferable in the neoadjuvant treatment of rectal cancer. Semin Radiat Oncol 2011; 21: 220–227

    Article  Google Scholar 

  33. Ngan SY, Burmeister B, Fisher RJ et al. Randomized trial of short-course radiotherapy versus long-course chemoradiation comparing rates of local recurrence in patients with T3 rectal cancer: Trans-Tasman Radiation Oncology Group trial 01.04. J Clin Oncol 2012; 30: 3827–3833

    Article  Google Scholar 

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Acknowledgments

We thank our colleague Chang Miawerl who provided some work that assisted the research.

Author Declaration

We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us.

Funding

This study was funded by grants from the Taiwan Clinical Oncology Research Foundation and from the Ministry of Science and Technology, Taiwan (MOST 105-2314-B-075-051; MOST 106-2314-B-075-062), and the Taipei Veterans General Hospital (V105C-132, V106C-166, V107C-120).

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Authors and Affiliations

  1. Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112, Taiwan

    Hao-Wei Teng

  2. School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Li-Nong Street, Taipei, 112, Taiwan

    Hao-Wei Teng, Jen-Kou Lin, Tzu-Chen Lin, Wei-Shone Chen, Jeng-Kai Jiang, Shung-Haur Yang, Huann-Sheng Wang, Shih-Ching Chang, Yuan-Tzu Lan, Chun-chi Lin, Hung-Hsin Lin & Sheng-Chieh Huang

  3. Division of Colon and Rectum Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112, Taiwan

    Jen-Kou Lin, Tzu-Chen Lin, Wei-Shone Chen, Jeng-Kai Jiang, Shung-Haur Yang, Huann-Sheng Wang, Shih-Ching Chang, Yuan-Tzu Lan, Chun-chi Lin, Hung-Hsin Lin & Sheng-Chieh Huang

  4. Department of Surgery, National Yang-Ming University Hospital, Yilan, Taiwan

    Shung-Haur Yang

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  1. Hao-Wei Teng
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Correspondence to Hao-Wei Teng.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors. This retrospective study was conducted based on population-based data from the Taipei Veterans General Hospital, Taipei, Taiwan, and under the guidelines of the Helsinki declaration, approved by the Human Subjects Protection Offices (IRB) at the Taipei Veterans General Hospital (VGHIRB number: 2015-07-003AC). Because all identifying patient information was removed prior to analysis in this study, informed consent was not obtained.

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Teng, HW., Lin, JK., Lin, TC. et al. Planned Short-Course Radiation (scRT) is Superior to Upfront Concurrent Chemoradiation (CCRT) in Treating Metastatic Rectal Cancer. J Gastrointest Surg 24, 1092–1100 (2020). https://doi.org/10.1007/s11605-019-04256-3

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  • DOI: https://doi.org/10.1007/s11605-019-04256-3

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