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Determining Which Patients Require Preoperative Pelvic Radiotherapy Before Curative-Intent Surgery and/or Ablation for Metastatic Rectal Cancer

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The aim of this study is to determine the optimal indications for preoperative pelvic radiotherapy (RT) in patients with metastatic rectal cancer who underwent curative-intent surgical resection and/or ablation.

Methods

Between January 2000 and October 2019, 246 patients who met our inclusion criteria were enrolled. Preoperative RT was performed in 22 patients (8.9%). Lower margin below the peritoneal reflection (p < 0.001), mesorectal fascia (MRF) invasion (p = 0.02), and lateral pelvic lymph node (LPLN) involvement (p = 0.005) were more frequent in the preoperative RT group.

Results

During the median follow-up period of 13.3 months (interquartile range [IQR]: 6.0–36.3 months), local recurrence (LR) was identified in 60 patients (24.4%). It was the first site of recurrence in 45 of them (18.3%). Among them, three patients were in the preoperative RT group. On multivariable analysis, lower margin below the peritoneal reflection, MRF invasion, LPLN involvement, carcinoembryonic antigen (CEA) level ≥ 10 ng/mL before treatment, and preoperative RT were significant prognostic factors for LR-free survival (LRFS). In the patient group without any risk factors, the 2-year LRFS rate was 94.9% without preoperative RT. In the patient group with one or more risk factors, the 2-year LRFS was 64.4% without and 95.2% with preoperative RT.

Conclusion

LR developed in about 25% of patients within 2 years. Preoperative RT should be considered, especially in patients with a risk factor for LR, including lower margin below the peritoneal reflection, MRF invasion, LPLN involvement, or CEA ≥ 10 ng/mL before treatment.

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Acknowledgment

We would like to thank Editage (www.editage.co.kr) for English language editing.

Funding

This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF), which is funded by the Ministry of Education (NRF-2020R1F1A1073205).

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Author notes

  1. Jeong Il Yu and Gyu Sang Yoo have contributed equally to this manuscript as first authors.

Authors and Affiliations

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

    Jeong Il Yu MD, PhD, Gyu Sang Yoo MD, PhD, Hee Chul Park MD, PhD & Doo Ho Choi MD, PhD

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

    Woo Yong Lee MD, PhD, Seong Hyeon Yun MD, PhD, Hee Cheol Kim MD, PhD, Yong Beom Cho MD, PhD, Jung Wook Huh MD, PhD, Yoon Ah Park MD & Jung Kyong Shin MD

  3. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Joon Oh Park MD, PhD, Seung Tae Kim MD, PhD, Young Suk Park MD, PhD, Jeeyun Lee MD, PhD, Won Ki Kang MD, PhD, Ho Yeong Lim MD, PhD & Jung Yong Hong MD, PhD

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  1. Jeong Il Yu MD, PhD
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Correspondence to Hee Chul Park MD, PhD or Woo Yong Lee MD, PhD.

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Yu, J.I., Yoo, G.S., Park, H.C. et al. Determining Which Patients Require Preoperative Pelvic Radiotherapy Before Curative-Intent Surgery and/or Ablation for Metastatic Rectal Cancer. Ann Surg Oncol 29, 4197–4207 (2022). https://doi.org/10.1245/s10434-022-11592-3

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