Responses of Patients with T3-4N0-2M0 Rectal Cancer to Preoperative Chemoradiotherapy: A Review of Current Literature
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Keywords

Rectal cancer
Preoperative rectal cancer chemoradiotherapy
Radiotherapy
oral surgery

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1.
Keita M, Bah M, Kondano SY, Camara A, Cisse IK, Barry MS, SHEN W. Responses of Patients with T3-4N0-2M0 Rectal Cancer to Preoperative Chemoradiotherapy: A Review of Current Literature. Integr J Med Sci [Internet]. 2022 Feb. 2 [cited 2022 Nov. 30];9. Available from: https://mbmj.org/index.php/ijms/article/view/617

Abstract

Objective: The study investigates the efficacy and safety of chemoradiotherapy and radiotherapy followed by surgery in patients with locally advanced unresectable rectal cancer.
Materials and Methods: We reviewed records for 65 patients with locally advanced unresectable rectal cancer treated by preoperative chemoradiotherapy or radiotherapy followed by surgery between 2013 and 2016. Of these, 23 patients were treated with preoperative chemoradiotherapy (40–45 Gy) plus concomitant chemotherapy (5-Fluorouracil + Calcium Folinate). For comparison, 42 similar patients treated by preoperative radiotherapy (45–50Gy) plus surgery served as controls. The primary endpoint of the study was overall survival and local control rate.
Results: No treatment plan was delayed because of toxicities in both groups. The radical resectability rate was 69.9% in the chemoradiotherapy group and 33.3% in the radiotherapy plus surgery group (p = 0. 024). The anal sphincter preservation rates were 26.6% and 3.7%, respectively (p = 0. 028). The anal sphincter preservation rates of lower rectal cancer were 27.3% and 0.0%, respectively (p = 0. 014). Response rates of chemoradiotherapy and radiotherapy plus surgery groups were 82.6% and 61.9% (p =  0. 053). The tumor downstage rates were 16 (69.6%) and 24 (57.1%) in these groups (p = 0. 206). The 3-year overall survival rates were 66.7% and 55.6% (p = 0. 485), and the tumor-free survival rates were 40. 3% and 33. 1% (p = 0. 663). The 3-year local recurrent rates were 26.9% and 48.1% (p = 0. 174). No obvious late effects were found in either group.
Conclusion: The results of this study suggested at least that acute side effects of preoperative chemoradiotherapy can be tolerated, and a higher surgical resection rate can be achieved. However, chemoradiotherapy did not improve the survival rate, whereas it increased local recurrence due to the high rate of anal sphincter preservation. It is safe and effective to use 5-Fluorouracil + Calcium Folinate and 5-DFUR as a radiosensitizer during the whole course of radiotherapy.

https://doi.org/10.15342/ijms.2022.617
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References

Bitterman DS, Resende-Salgado L, Moore HG, Sanfilippo NJ, Gu P, Hatzaras I, et al. Predictors of Complete Response and Recurrence Following Neoadjuvant Chemoradiation Therapy in Rectal Cancer. Radiation Oncol Biol Physic. 2015; 93 (3): E145-E146. https://doi.org/10.1016/j.ijrobp.2015.07.919

Callegaro D, Miceli R, Brunelli C, Colombo C, Sanfilippo R, Radaelli S, et al. Long-term morbidity after multivisceral resection for retroperitoneal sarcoma, Br J Surg. 2015 Aug; 102(9): 1079–1087. https://doi.org/10.1002/bjs.9829

De Caluwe L, Van Nieuwenhove Y, Ceelen WP. Preoperative chemoradiation versus radiation alone for stage II and III resectable rectal cancer. Cochrane Database Syst Rev. 2013 Feb 28 ;(2): CD006041. https://doi.org/10.1002/14651858.cd006041.pub3

Jin F, Luo H, Zhou J, Wu Y, Sun H, Liu H, et al. Dose-time fractionation schedules of preoperative radiotherapy and timing to surgery for rectal cancer. Ther Adv Med Oncol. 2020 Feb 29; 12:1758835920907537. https://doi.org/10.1177/1758835920907537

Valentini V, Coco C, Cellini N, Picciocchi A, Fares MC, Rosetto ME, et al. Ten years of preoperative chemoradiation for extraperitoneal T3 rectal cancer: acute toxicity, tumor response, and sphincter preservation in three consecutive studies. Int J Radiat Oncol Biol Phys. 2001 Oct 1; 51(2):371-83. https://doi.org/10.1016/s0360-3016(01)01618-2

Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010 Jun; 17(6):1471-4. https://doi.org/10.1245/s10434-010-0985-4

Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumors: revised RECIST guideline (version 1.1). Eur J Cancer. 2009 Jan; 45(2):228-47. https://doi.org/10.1016/j.ejca.2008.10.026

Gérard JP, Chamorey E, Gourgou-Bourgade S, Benezery K, de Laroche G, Mahé MA, et al. Clinical complete response (cCR) after neoadjuvant chemoradiotherapy and conservative treatment in rectal cancer. Findings from the ACCORD 12/PRODIGE 2 randomized trial. Radiother Oncol. 2015 May; 115(2):246-52. https://doi.org/10.1016/j.radonc.2015.04.003

Fucini C, Pucciani F, Elbetti C, Gattai R, Russo A. Preoperative radiochemotherapy in t3 operable low rectal cancers: a gold standard? World J Surg. 2010 Jul;34(7):1609-14. https://doi.org/10.1007/s00268-010-0513-5

Cellier P, Leduc B, Martin L, Vié B, Chevelle C, Vendrely V, et al. Phase II study of preoperative radiation plus concurrent daily tegafur-uracil (UFT) with leucovorin for locally advanced rectal cancer. BMC Cancer. 2011 Mar 16; 11:98. https://doi.org/10.1186/1471-2407-11-98

Nakagawa R, Inoue Y, Ohki T, Kaneko Y, Maeda F, Yamamoto M. Efficacy and short-term outcomes of preoperative chemoradiotherapy with intermittent oral tegafur-uracil plus leucovorin in Japanese rectal cancer patients: a single center experience retrospective analysis. World J Surg Oncol. 2017 May 31; 15(1):112. https://doi.org/10.1186/s12957-017-1177-5

Tomoda H, Morita M, Matsuoka H, Baba H, Taketomi A, Kohnoe S, et al. [Pyrimidine nucleoside phosphorylase activity, 5-fluorouracil concentration and thymidylate synthase inhibition rate in colorectal cancer after oral administration of 5'-doxifluridine]. Gan To Kagaku Ryoho. 1997 Jun;24(8):971-4.

Zheng JF, Wang HD. 5-Fluorouracil concentration in blood, liver and tumor tissues and apoptosis of tumor cells after preoperative oral 5'-deoxy-5-fluorouridine in patients with hepatocellular carcinoma. World J Gastroenterol. 2005 Jul 7; 11(25):3944-3947. https://doi.org/10.3748/wjg.v11.i25.3944

Pucciarelli S, Toppan P, Friso ML, Russo V, Pasetto L, Urso E, et al. Complete pathologic response following preoperative chemoradiation therapy for middle to lower rectal cancer is not a prognostic factor for a better outcome. Dis Colon Rectum. 2004 Nov; 47(11):1798-807. https://doi.org/10.1007/s10350-004-0681-1

Wiegering A, Isbert C, Dietz UA, Kunzmann V, Ackermann S, Kerscher A, et al. Multimodal therapy in treatment of rectal cancer is associated with improved survival and reduced local recurrence - a retrospective analysis over two decades. BMC Cancer. 2014 Nov 6; 14:816. https://doi.org/10.1186/1471-2407-14-816

Birgisson H, Påhlman L, Gunnarsson U, Glimelius B; Swedish Rectal Cancer Trial Group. Adverse Effects of Preoperative Radiation Therapy for Rectal Cancer: Long-Term Follow-Up of the Swedish Rectal Cancer Trial. J Clin Oncol. 2005 Dec 1; 23(34):8697-705. https://doi.org/10.1200/jco.2005.02.9017

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Copyright (c) 2021 Mamady Keita, Bah Malick, Kondano SY, Camara A, Ibrahima Kalil Cisse, Barry MS, Shen Wenbin

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