Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 4/2009

01-04-2009 | Gastrointestinal Oncology

Long-Term Oncologic Results and Complications After Preoperative Chemoradiotherapy for Rectal Cancer: A Single-Institution Experience After a Median Follow-Up of 95 Months

Authors: Salvatore Pucciarelli, MD, Giuseppe Gagliardi, MD, Isacco Maretto, MD, Sara Lonardi, MD, Maria Luisa Friso, MD, Emanuele Urso, MD, Paola Toppan, MD, Donato Nitti, MD

Published in: Annals of Surgical Oncology | Issue 4/2009

Login to get access

Abstract

Background

This study sought to evaluate the long-term outcome and complications, and occurrence of second malignancy after preoperative chemoradiotherapy (pCRT) for rectal cancer.

Methods

One hundred twenty-three consecutive patients (78 men, 45 women) with locally advanced mid-low rectal cancer underwent pCRT between 1994 and 2002. Patients were followed up by one surgeon with a standard protocol, and data were prospectively recorded in a dedicated database. No patient was lost to follow-up. Complications were defined as late if they occurred >6 months after surgery. Overall and disease-free survival were calculated by the Kaplan-Meier method.

Results

Of 123 patients, 111 underwent an R0 procedure. The rate of pathologic complete response was 16% (n = 20 patients). At a median follow-up of 95 (range, 56–160) months, 50 late complications occurred in 41 patients, 21 of whom required surgery. In seven cases, the complications were clearly CRT related and were significantly associated with the total dose of radiation delivered (P < .05). The estimated 5- and 10-year overall survival was 76% and 67%, respectively. The estimated 5- and 10-year disease-free survival was 83% and 82%, respectively. In 18 of 19 patients who experienced recurrence (local, n = 3; distant, n = 16), it occurred within 48 months from surgery. The most frequent site of metastasis as first site of recurrence was the lung (9 of 19). The most frequent second primary malignancy was lung cancer (3 of 8).

Conclusions

Despite satisfactory oncological outcome, late morbidity after pCRT is relevant and related to the radiotherapy dose used. Most recurrences and second malignancies were located in the lung.
Literature
1.
Sauer R, Becker H, Hohenberger W et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351:1731–40.PubMedCrossRef
2.
Bosset JF, Collette L, Calais G et al. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med. 2006;355:1114–23.PubMedCrossRef
3.
Gérard JP, Conroy T, Bonnetain F et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol. 2006;24:4620–5.PubMedCrossRef
4.
Bujko K, Nowacki MP, Nasierowska-Guttmejer A et al. Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg. 2006;93:1215–23.PubMedCrossRef
5.
Sauer R, Fietkau R, Wittekind C et al. Adjuvant vs. neoadjuvant radiochemotherapy for locally advanced rectal cancer: the German trial CAO/ARO/AIO-94. Colorectal Dis. 2003;5:406–15.PubMedCrossRef
6.
Pucciarelli S, Friso ML, Toppan P et al. Preoperative combined radiotherapy and chemotherapy for middle and lower rectal cancer: preliminary results. Ann Surg Oncol. 2000;7:38–44.PubMedCrossRef
7.
Fleming DI, Cooper SJ, Henson ED et al. AJCC cancer staging manual. 5th ed. Philadelphia: Lippincott-Raven; 1997. p. 83–90.
8.
Birgisson H, Påhlman L, Gunnarsson U, Glimelius B. Adverse effects of preoperative radiation therapy for rectal cancer. J Clin Oncol. 2005;23:8697–705.PubMedCrossRef
9.
Pucciarelli S, Urso E, DeSalvo GL et al. 5-fluorouracil and weekly oxaliplatin combined with radiotherapy for locally advanced rectal cancer: surgical complications and long-term results. Arch Med Res. 2006;37:860–5.PubMedCrossRef
10.
Guillem JG, Chessin DB, Cohen AM et al. Long-term oncologic outcome following preoperative combined modality therapy and total mesorectal excision of locally advanced rectal cancer. Ann Surg. 2005;241:829–36.PubMedCrossRef
11.
Chessin DB, Enker W, Cohen AM et al. Complications after preoperative combined modality therapy and radical resection of locally advanced rectal cancer: a 14-year experience from a specialty service. J Am Coll Surg. 2005;200:876–82.PubMedCrossRef
12.
Pollack J, Holm T, Cedermark B et al. Late adverse effects of short-course preoperative radiotherapy in rectal cancer. Br J Surg. 2006;93:1519–25.PubMedCrossRef
13.
Laurent C, Leblanc F, Bretagnol F, Capdepont M, Rullier E. Long-term advantages of the laparoscopic approach in rectal cancer. Br J Surg. 2008;95:903–8.PubMedCrossRef
14.
Romano G, Gagliardi G, Bianco F, Parker MC, Corcione F. Laparoscopic colorectal surgery: why it is still not the gold standard and why it should be. Tech Coloproctol. 2008;12:185–8.PubMedCrossRef
15.
Wiltshire KL, Ward IG, Swallow C et al. Preoperative radiation with concurrent chemotherapy for resectable rectal cancer: effect of dose escalation on pathologic complete response, local recurrence-free survival, disease-free survival, and overall survival. Int J Radiat Oncol Biol Phys. 2006;64:709–16.PubMed
16.
Peeters KC, Marijnen CA, Nagtegaal ID et al. The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg. 2007;246:693–701.PubMedCrossRef
17.
Coco C, Valentini V, Manno A et al. Long-term results after neoadjuvant radiochemotherapy for locally advanced resectable extraperitoneal rectal cancer. Dis Colon Rectum. 2006;49:311–8.PubMedCrossRef
18.
Platell CF. Changing patterns of recurrence after treatment for colorectal cancer. Int J Colorectal Dis. 2007;22:1223–31.PubMedCrossRef
19.
Tjandra JJ, Chan MK. Follow-up after curative resection of colorectal cancer: a meta-analysis. Dis Colon Rectum. 2007;50:1783–99.PubMedCrossRef
20.
Renehan AG, O’Dwyer ST, Whynes DK. Cost effectiveness analysis of intensive versus conventional follow up after curative resection for colorectal cancer. BMJ. 2004;328:81.PubMedCrossRef
21.
Figueredo A, Rumble RB, Maroun J et al. Follow-up of patients with curatively resected colorectal cancer: a practice guideline. BMC Cancer. 2003;3:26.PubMedCrossRef
22.
Jeffery M, Hickey BE, Hider PN. Follow-up strategies for patients treated for non-metastatic colorectal cancer. Cochrane Database Syst Rev. 2007;(1):CD002200.
23.
Glimelius B, Oliveira J. Rectal cancer: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol. 2008;19(Suppl 2):ii31–2.PubMedCrossRef
24.
Anthony T, Simmang C, Hyman N et al. Practice parameters for the surveillance and follow-up of patients with colon and rectal cancer. Dis Colon Rectum. 2004;47:807–17.PubMedCrossRef
25.
Scholefield JH, Steele RJ. Guidelines for follow up after resection of colorectal cancer. Gut. 2002;51(Suppl 5):v3–5.PubMedCrossRef
26.
Makela JT, Laitinen OS, Kairaluoma MI. Five-year follow-up after radical surgery for colorectal cancer: results of a prospective randomized trial. Arch Surg. 1995;130:1062–7.PubMed
27.
Schoemaker D, Black R, Giles L, Toouli J. Yearly colonoscopy, liver CT, and chest radiography do not influence 5-year survival of colorectal cancer patients. Gastroenterology. 1998;114:7–14.PubMedCrossRef
28.
Desch CE, Benson AB III, Somerfield MR et al. Colorectal cancer surveillance: 2005 update of an American Society of Clinical Oncology practice guideline. J Clin Oncol. 2005;23:8512–9.PubMedCrossRef
Metadata
Title
Long-Term Oncologic Results and Complications After Preoperative Chemoradiotherapy for Rectal Cancer: A Single-Institution Experience After a Median Follow-Up of 95 Months
Authors
Salvatore Pucciarelli, MD
Giuseppe Gagliardi, MD
Isacco Maretto, MD
Sara Lonardi, MD
Maria Luisa Friso, MD
Emanuele Urso, MD
Paola Toppan, MD
Donato Nitti, MD
Publication date
01-04-2009
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 4/2009
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-009-0335-6

Other articles of this Issue 4/2009

Annals of Surgical Oncology 4/2009 Go to the issue

Breast Oncology

Timing of Axillary Staging

Hepatobiliary and Pancreatic Tumors

Differentiating Early and Late Recurrences After Resection of HCC in Cirrhotic Patients: Implications on Surveillance, Prevention, and Treatment Strategies

Head and Neck Oncology

In Reply

Thoracic Oncology

Lung Cancer as a Second Primary Malignancy: Increasing Prevalence and Its Influence on Survival

Gastrointestinal Oncology

Genome-Wide Association Studies and Aggressive Surgery Toward Individualized Prevention, and Improved Local Control and Overall Survival for Gastric Cancer

Head and Neck Oncology

Impact of Hospital Volume on Surgical Outcome for Head and Neck Cancer