Abstract
BackgroundNeoadjuvant chemoradiotherapy is regarded as the standard of treatment for locally advanced lower rectal cancer, although some of these cases are systemic, and distant control may be inadequate. Neoadjuvant chemotherapy could compensate for such shortcomings, potentially yielding better survival outcomes. We aimed to stratify patients into prognostic groups on the basis of preoperative factors, including response to neoadjuvant chemotherapy.MethodsWe retrospectively analyzed patients with locally advanced lower rectal adenocarcinoma (clinical stage II/III with high-risk features of distant metastasis) who were treated with neoadjuvant chemotherapy (without radiotherapy) followed by curative resection between 2010 and 2017. Reduction in tumor volume (before vs. after neoadjuvant chemotherapy) was measured using magnetic resonance imaging, and a reduction above 60% was defined as a good response. Recurrence and overall survival were evaluated.ResultsThe cohort comprised 102 patients. Good response to neoadjuvant chemotherapy was associated with better 5-year recurrence-free survival (good responders: 81.1%, poor responders: 49.0%; p = 0.001) and 5-year overall survival (good responders: 94.9%, poor responders: 80.6%; p = 0.06). In a multivariate analysis, extramural venous invasion on magnetic resonance imaging after neoadjuvant chemotherapy and a tumor volume reduction rate < 60 were found to be significantly and independently associated with worse recurrence-free survival (hazard ratio: 2.74, 95% confidence interval: 1.36–5.50, p = 0.005 and hazard ratio: 3.48, 95% confidence interval: 1.57–7.72, p = 0.002, respectively). Good responders without extramural venous invasion had the best 5-year recurrence-free and overall survival (89.0 and 93.8%, respectively). Poor responders with extramural venous invasion had the worst 5-year recurrence-free and overall survival (21.4 and 50.0%, respectively).ConclusionsReductions in tumor volume after neoadjuvant chemotherapy were associated with a better prognosis in patients with locally advanced lower rectal cancer. Extramural venous invasion was a preoperative prognostic factor.
Highlights
Neoadjuvant chemoradiotherapy is regarded as the standard of treatment for locally advanced lower rectal cancer, some of these cases are systemic, and distant control may be inadequate
We considered that the response of locally advanced lower rectal cancer (LALRC) to neoadjuvant chemotherapy (NAC) might predict the emergence of distant recurrence postoperatively
Patients and study design We retrospectively analyzed all patients with locally advanced lower rectal adenocarcinoma who received NAC followed by curative resection at the National Cancer Center Hospital East, Japan, between January 2010 and February 2017
Summary
Neoadjuvant chemoradiotherapy is regarded as the standard of treatment for locally advanced lower rectal cancer, some of these cases are systemic, and distant control may be inadequate. Neoadjuvant chemotherapy could compensate for such shortcomings, potentially yielding better survival outcomes. The prognosis of locally advanced lower rectal cancer (LALRC) might be improved by individualizing treatment. The standard treatment for LALRC is neoadjuvant chemoradiotherapy (NACRT), followed by total mesorectal excision (TME) [1, 2]. This combination is generally thought to be essential and is performed for almost all patients. NAC could compensate for such shortcomings, potentially yielding better survival outcomes. Only few studies have reported the efficacy of NAC for LALRC without NACRT [7, 8]
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