Abstract
BackgroundThe optimal care for pT3N0 rectal cancer remains controversial. And whether tumor location can be used to guide the administration of adjuvant radiotherapy for pT3N0 rectal cancer is not fully confirmed. The current study was designed to identify the benefit of adjuvant radiotherapy for pT3N0 rectal cancer.MethodsWe performed a retrospective study of 265 pT3N0 rectal cancer patients who were treated by surgery and adjuvant therapy from Mar. 2005 to Sept. 2015. All patients were divided into two groups according to receiving adjuvant radiotherapy or not. Overall survival (OS), disease-free survival (DFS) were compare between patients who did and did not receive adjuvant radiotherapy. Multivariate analysis was performed to explore clinical factors significantly associated with DFS, local recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS).ResultsFor patients with lower tumor, DFS in adjuvant chemo-radiotherapy group was higher than that in adjuvant chemotherapy group. Besides, the rates of local recurrence and distant metastasis were found lower in patients who did receive adjuvant radiotherapy than those who did not. For patients with upper tumor, the 5-year OS and DFS were similar between groups of adjuvant chemotherapy and adjuvant chemo-radiotherapy. Multivariable analysis indicated both the CEA and tumor location were independent predictors of LRFS. And adjuvant radiotherapy predicted the DFS, LRFS and DMFS in lower rectal cancer patients.ConclusionTumor location can serve as an indication for the administration of adjuvant radiotherapy in pT3N0 rectal cancer patients.
Highlights
The treatment of rectal cancer has rapidly evolved during the last 15 years with an increasing use of preoperative chemoradiotherapy for locally advanced disease, which has markedly improved the quality of life and survival of rectal cancer patients [1]
Our current study demonstrated that no significant differences were found in both Overall survival (OS) and disease-free survival (DFS) in pT3N0 rectal cancer patients who received adjuvant chemo-radiotherapy compared to adjuvant chemotherapy
In patients with mid and lower rectal cancer, the local recurrence rate was not affected by radiotherapy [7, 14], which was contradicted to our findings
Summary
The treatment of rectal cancer has rapidly evolved during the last 15 years with an increasing use of preoperative chemoradiotherapy for locally advanced disease, which has markedly improved the quality of life and survival of rectal cancer patients [1]. Studies reported that the rates of local recurrence ranged from 4.1 to 6.5% in pT3N0 rectal patients who received TME surgery alone [2, 3]. Several studies have reported that adjuvant radiotherapy may not improve the survival and local control rate in pT3N0 rectal cancer [6–8]. They suggested that post-operative adjuvant radiation may be unneeded and over-treatment for patients with pT3N0 stage. Whether tumor location can be used to guide the administration of adjuvant radiotherapy for pT3N0 rectal cancer is not fully confirmed. The current study was designed to identify the benefit of adjuvant radiotherapy for pT3N0 rectal cancer
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