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Determining whether postoperative chemoradiotherapy is required in patients with pathologic T3N0 rectal cancer with negative resection margin

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to identify the risk factors for locoregional recurrence (LR) and determine possible candidates for postoperative concurrent chemoradiotherapy (CCRT) in pathologic T3N0 (pT3N0) rectal cancer patients with a negative resection margin after total mesorectal excision (TME).

Method

Data from 365 patients who had pT3N0 rectal cancer between 2003 and 2012 in the Samsung Medical Center were reviewed. All patients underwent upfront surgery without preoperative treatment. Postoperative management involved either no adjuvant therapy (n = 122), chemotherapy alone (n = 100), or CCRT (n = 143).

Results

The median follow-up duration was 71 months. The 5-year overall survival, disease-free survival, and LR-free survival (LRFS) rates were 95.9%, 86.9%, and 96.3%, respectively. When comparing the three groups (surgery alone [n = 122], chemotherapy alone [n = 100], and CCRT [n = 143]), there was no significant difference in LRFS among them (94.0%, 93.4%, and 99.2%, respectively; p = 0.20). However, when patients were stratified by risk factors (distance from anal verge ≤ 5 cm and distal resection margin [DRM] ≤ 2 cm), the 5-year LRFS improved by more than 10% by adding CCRT (98.9% with CCRT vs. 87.4% without CCRT, p = 0.006) in those with more than one risk factor. Postoperative CCRT did not affect the 5-year LRFS (100% with CCRT vs. 99.0% without CCRT, p = 0.66) in patients with no risk factors.

Conclusion

Postoperative CCRT significantly decreased LR in patients with pT3N0 rectal cancer with a negative resection margin but having a distance from the anal verge ≤ 5 cm or DRM ≤ 2 cm.

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Funding

This research was supported by a Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2017R1D1A1B03031275).

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Authors and Affiliations

  1. Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Jong Yun Baek, Jeong Il Yu, Hee Chul Park, Doo Ho Choi & Gyu Sang Yoo

  2. Department of General Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Woo Yong Lee, Seong Hyeon Yun, Yong Beom Cho, Yoon Ah Park & Hee Cheol Kim

  3. Department of Radiation Oncology, Gangbook Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Heerim Nam

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  1. Jong Yun Baek
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  2. Jeong Il Yu
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Corresponding authors

Correspondence to Jeong Il Yu or Hee Chul Park.

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The present study was approved and exempted from requiring participant consent by the Samsung Medical Center institutional review board (IRB No. 2019-08-071).

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The authors declare that they have no conflict of interest.

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Baek, J.Y., Yu, J.I., Park, H.C. et al. Determining whether postoperative chemoradiotherapy is required in patients with pathologic T3N0 rectal cancer with negative resection margin. Int J Colorectal Dis 35, 2239–2248 (2020). https://doi.org/10.1007/s00384-020-03701-z

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  • DOI: https://doi.org/10.1007/s00384-020-03701-z

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