TY - JOUR
T1 - Neoadjuvant radiotherapy in rectal cancer – less is more?
AU - Jootun, N.
AU - Sengupta, S.
AU - Cunningham, C.
AU - Charlton, P.
AU - Betts, M.
AU - Weaver, A.
AU - Jacobs, C.
AU - Hompes, R.
AU - Muirhead, R.
PY - 2020/3/1
Y1 - 2020/3/1
N2 - Aim: There is significant international variation in the use of neoadjuvant radiation prior to total mesorectal excision. The MERCURY group advocate selective neoadjuvant chemoradiotherapy (CRT). We have performed a retrospective, single-centre study of patients treated with CRT, where only the circumferential resection margin is threatened, with the aim of identifying whether a more selective approach to CRT provides acceptable local relapse rates (LRRs). Method: All consecutive patients who underwent radical surgery for rectal adenocarcinoma over a 5-year period (2007–2012) in the Oxford University Trust were considered. Electronic hospital systems were reviewed to obtain patient and tumour demographics, treatment and follow-up information. All patients were classified into risk categories according to National Institute for Health and Care Excellence guidance. Data were analysed using Microsoft Excel and R. Results: Two hundred and seventy-two patients were identified: 123, 89 and 60 in the high-, intermediate- and low-risk categories, respectively. Seventy-nine per cent of those in the high-risk group, 6% in the intermediate and 5% in the low-risk group underwent CRT. The overall 5-year LRR and distant recurrence rate (DRR) were 5.2% and 17.8%, respectively. The 5-year LRR for those who went straight to surgery was 2.0% and for those who had neoadjuvant CRT it was 7.4%. The DRR for these two groups was 8.5% and 18.9%, respectively. Conclusion: Our series demonstrates that the use of CRT only in margin-threatening tumours, results in an exceptionally low LRR for those without margin-threatening disease. In routine clinical care, this strategy can minimize the significant morbidity of multimodal treatment and allow earlier introduction of systemic therapy to minimize distant recurrence.
AB - Aim: There is significant international variation in the use of neoadjuvant radiation prior to total mesorectal excision. The MERCURY group advocate selective neoadjuvant chemoradiotherapy (CRT). We have performed a retrospective, single-centre study of patients treated with CRT, where only the circumferential resection margin is threatened, with the aim of identifying whether a more selective approach to CRT provides acceptable local relapse rates (LRRs). Method: All consecutive patients who underwent radical surgery for rectal adenocarcinoma over a 5-year period (2007–2012) in the Oxford University Trust were considered. Electronic hospital systems were reviewed to obtain patient and tumour demographics, treatment and follow-up information. All patients were classified into risk categories according to National Institute for Health and Care Excellence guidance. Data were analysed using Microsoft Excel and R. Results: Two hundred and seventy-two patients were identified: 123, 89 and 60 in the high-, intermediate- and low-risk categories, respectively. Seventy-nine per cent of those in the high-risk group, 6% in the intermediate and 5% in the low-risk group underwent CRT. The overall 5-year LRR and distant recurrence rate (DRR) were 5.2% and 17.8%, respectively. The 5-year LRR for those who went straight to surgery was 2.0% and for those who had neoadjuvant CRT it was 7.4%. The DRR for these two groups was 8.5% and 18.9%, respectively. Conclusion: Our series demonstrates that the use of CRT only in margin-threatening tumours, results in an exceptionally low LRR for those without margin-threatening disease. In routine clinical care, this strategy can minimize the significant morbidity of multimodal treatment and allow earlier introduction of systemic therapy to minimize distant recurrence.
KW - Local recurrence
KW - chemoradiotherapy
KW - disease-free survival
KW - extramural vascular invasion
KW - short-course preoperative radiotherapy
KW - total mesorectal excision
UR - http://www.scopus.com/inward/record.url?scp=85074357660&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/codi.14863
DO - https://doi.org/10.1111/codi.14863
M3 - Article
C2 - 31556218
SN - 1462-8910
VL - 22
SP - 261
EP - 268
JO - Colorectal disease
JF - Colorectal disease
IS - 3
ER -