Abstract
ObjectivesThe purposes of this study were to determine whether neoadjuvant or adjuvant radiotherapy affected disease-specific survival (DSS) in patients with rectal cancer and whether stratification by tumor stage affected the results.Results55.5% patients had neoadjuvant-radiotherapy (NRT), and 18.3% patients had adjuvant- radiotherapy (ART). Multivariable models showed that treatment type was independently associated with DSS. Patients with stages III/IV tumors who received ART plus chemotherapy had significantly worse DSS than did those who received NRT plus chemotherapy (NCRT) (P = 0.03). Among patients with stage II tumors, those who received ART plus chemotherapy and those who received NCRT had similar DSS. Further stratification by risk group revealed that patients with stage IIIA tumors who received ART plus chemotherapy had significantly better DSS than did those who received NCRT (P = 0.04). The ART plus chemotherapy and NCRT groups had similar DSS in patients with stage IIA tumors. Among high-risk patients (T3N+/T4), the NCRT group had significantly better DSS than did the ART plus chemotherapy group. Patients who underwent surgery only had the worst DSS of all the treatment groups.Materials and MethodsFrom the Surveillance, Epidemiology, and End Results database, patients diagnosed with stages II–IV rectal cancer from 2004–2014 were identified. Clinicopathologic features, treatments, and DSS in different treatment groups were compared.ConclusionsNCRT or ART plus chemotherapy can reduce deaths from rectal cancer. Patients with stage IIIA tumors will benefit most from ART plus chemotherapy, whereas NCRT should be recommended to patients with stages II, IIIB, or higher tumors.
Highlights
Colorectal cancer is the third most common cancer in the US and the third leading cause of cancer death [1]
Patients with stage IIIA tumors will benefit most from adjuvant- radiotherapy (ART) plus chemotherapy, whereas neoadjuvant chemoradiotherapy (NCRT) should be recommended to patients with stages II, IIIB, or higher tumors
When we broke down the high-risk group to stage IIB (N = 1,036), stage IIIB (N = 7,860), stage IIIC (N = 4,143), we found the similar trends in those groups
Summary
Colorectal cancer is the third most common cancer in the US and the third leading cause of cancer death [1]. Rectal cancer, which makes up nearly one-third of colorectal cancer cases [2], is often difficult to treat and carries a much higher risk of local recurrence. Because of this high risk, radiotherapy is often added to the standard treatment for rectal cancer, surgery. The availability of endorectal ultrasonography and new magnetic resonance imaging technologies has improved preoperative staging, making neoadjuvant chemoradiotherapy (NCRT) the current standard of care for patients with locally advanced rectal cancer [6,7,8]. Many patients with locally advanced rectal cancers still do not receive NCRT because their disease is understaged on preoperative imaging studies
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