Top

Published in:

01-02-2022 | Rectal Cancer | Original Article

Neoadjuvant chemoradiotherapy for locally advanced rectal cancer with peritumoral abscesses and fistulas

Authors: Sergey Gordeyev, Valerii Ivanov, Mikhail Fedianin, Marina Chernikh, Nikolay Kozlov, Leonid Petrov, Dmitriy Erygin, Ivan Gridasov, Valery Kaushanskiy, Dmitry Feoktistov, Zaman Mamedli

Published in: Strahlentherapie und Onkologie | Issue 2/2022

Abstract

Purpose

Rectal cancer patients who present with peritumoral abscesses and fistulas at the time of diagnosis may be denied chemoradiotherapy (CRT) as the safety is unknown. The aim of this study was to investigate the safety of preoperative CRT in this patient group.

Methods

We performed a retrospective nested case–control study to compare outcomes between patients with locally advanced rectal cancer with peritumoral abscesses and fistulas (study group) and patients with T4 locally advanced rectal cancer with no evidence of abscesses and fistulas (control group). These groups were matched by treatment center and radiotherapy delivery method. All patients received 50–54 Gy of conventionally fractionated RT with concurrent chemotherapy. Primary endpoint was grade 3–5 toxicity (by National Cancer Institute Common Toxicity Criteria for Adverse Events (NCI CTCAE). Secondary endpoints included postoperative morbidity, pathologic complete response (pCR), disease-free survival (DFS), and overall survival (OS) at 2 years.

Results

A total of 33 patients were included in each group. Grade 3 toxicity was observed in 2 (6.1%) patients in the study group and 4 (12.1%) patients in the control group (p = 0.672). No patients developed grade 4–5 toxicity. Grade 3–4 Clavien–Dindo complications were observed in 5 (15.2%) patients in the study group and in 6 (18.2%) patients in the control group (p = 1.0). Pathologic CR was achieved in 3 (9.1%) and 5 (15.2%) patients, respectively (p = 0.708). Two-year OS was 78.3% vs. 81.8% (p = 0.944), 2‑year DFS was 62.8% vs. 69.7% (p = 0.693), respectively.

Conclusion

The presence of peritumoral abscesses and fistulas in patients with locally advanced rectal cancer is not associated with increased toxicity or inferior clinical outcomes after preoperative CRT.

Available only for authorised users

Cameron MG, Kersten C, Vistad I, van Helvoirt R, Weyde K, Undseth C, Mjaaland I, Skovlund E, Fossa SD, Guren MG (2016) Palliative pelvic radiotherapy for symptomatic rectal cancer—a prospective multicenter study. Acta Oncol 55(12):1400–1407. https://doi.org/10.1080/0284186X.2016.1191666CrossRefPubMed

Bacalbasa N, Bãlescu I (2015) Total pelvic exenteration for locally invasive cervical cancer with vesico-vaginal fistula. Mod Med 22(1):73–77

Matsumoto T, Nakanishi M, Miyamae M, Takao K, Fukunaga T, Otsuji E (2017) A case of locally advanced rectal cancer with abscess and rectovesical fistula curatively resected following preoperative chemotherapy. Gan To Kagaku Ryoho 44(12):1482–1484PubMed

el Benjelloun B, Aitalalim S, Chbani L, Mellouki I, Mazaz K, Aittaleb K (2012) Rectosigmoid adenocarcinoma revealed by metastatic anal fistula. The visible part of the iceberg: a report of two cases with literature review. World J Surg Oncol 10:209. https://doi.org/10.1186/1477-7819-10-209CrossRefPubMedCentral

Kitahara T, Uemura M, Haraguchi N, Nishimura J, Shingai T, Hata T, Takemasa I, Mizushima T, Doki Y, Mori M, Yamamoto H (2014) Successful treatment of rectal cancer with perineal invasion: three case reports. mol clin onc 2(4):497–500. https://doi.org/10.3892/mco.2014.282CrossRef

Mitrushi A, Bilali S, Bilali V, Mitrushi F, Mehmeti E (2017) A clinical case of perineal invasion from rectal carcinoma. G Chir 38(4):199–201CrossRef

Miyakawa T, Iida S, Igaki T, Shiobara H, Matsumoto R, Mitachi K, Ohata Y, Saito K, Miura T, Irie T, Yamazaki S (2017) Neoadjuvant chemoradiotherapy for locally advanced carcinoma associated with anal fistula. Gan To Kagaku Ryoho 44(12):1437–1439PubMed

Kuroda M, Ikeda E, Yokoyama N, Kenmotsu M, Takagi S, Yamano T (2016) A case of carcinoma associated with an anal fistula repaired using a hatchet flap after neoadjuvant chemoradiotherapy. Gan To Kagaku Ryoho 43(12):1650–1652PubMed

Morikawa T, Yamashita K, Sumi Y, Kanemitsu K, Yamamoto M, Kanaji S, Imanishi T, Nakamura T, Suzuki S, Tanaka K, Kakeji Y (2014) Laparoscopic abdominoperineal resection after preoperative chemoradiotherapy for advanced carcinoma associated with anal fistula. Gan To Kagaku Ryoho 41(12):1875–1877PubMed

10.

Ishigame T, Momma T, Suzuki S, Nakamura I, Ohki S, Koyama Y, Takenoshita S (2012) A case of carcinoma associated with anal fistula in which reconstruction using a gracilis musculocutaneous flap was performed after preoperative chemoradiotherapy. Gan To Kagaku Ryoho 39(12):1957–1959PubMed

11.

Yaegashi M, Otsuka K, Kimura T, Matsuo T, Sato K, Takashimizu K, Hatanaka T, Yoshida T, Tono C, Minagawa Y (2017) A case of more than five-year survival of carcinoma associated with anal fistula effectively treated by combined modality therapy. Gan To Kagaku Ryoho 44(12):1754–1756PubMed

12.

Zhan T, Wang L, Li M, Li Z, Cai Y, Shen L, Gu J (2012) A multidisciplinary clinical treatment of locally advanced rectal cancer complicated with rectovesical fistula: a case report. J Med Case Reports 6:369. https://doi.org/10.1186/1752-1947-6-369CrossRef

13.

Schwartz LH, Litière S, de Vries E, Ford R, Gwyther S, Mandrekar S, Shankar L, Bogaerts J, Chen A, Dancey J (2016) RECIST 1.1—Update and clarification: from the RECIST committee. Eur J Cancer 62:132–137CrossRef

14.

Kuwabara H, Watanabe S, Liu B, Mitsuoka A, Sanada T, Nakajima K, Goseki N (2013) A case of locally advanced colorectal cancer with abscess responding to 5‑fluorouracil, leucovorin, and oxaliplatin plus bevacizumab. Gan To Kagaku Ryoho 40(12):2032–2034PubMed

15.

Nakayasu Y, Yoshimatsu K, Yokomizo H, Osawa G, Yano Y, Nakayama M, Sakuma A, Yamaguchi K, Shiozawa S, Shimakawa T, Katsube T, Naritaka Y (2013) Two cases of locally advanced colorectal cancer curatively resected after neoadjuvant chemotherapy with 5‑fluorouracil, leucovorin, and oxaliplatin plus panitumumab. Gan To Kagaku Ryoho 40(12):2029–2031PubMed

16.

Murata A, Takatsuka S, Shinkawa H, Kaizaki R, Hori T, Ikehara T (2014) A case report of metastatic anal fistula cancer treated with neoadjuvant chemotherapy. Gan To Kagaku Ryoho 41(12):1869–1871PubMed

17.

Nushijima Y, Nakano K, Sugimoto K, Nakaguchi K, Kan K, Maruyama H, Doi S, Okamura S, Murata K (2014) A case of primary carcinoma associated with anal fistula. Gan To Kagaku Ryoho 41(12):1872–1874PubMed

18.

Cui J, Fang H, Zhang L, Wu YL, Zhang HZ (2016) Advances for achieving a pathological complete response for rectal cancer after neoadjuvant therapy. Chronic Dis Transl Med 2(1):10–16. https://doi.org/10.1016/j.cdtm.2016.06.001CrossRefPubMedPubMedCentral

19.

Pechlivanides G, Gourtsoyianni S, Gouvas N, Sougklakos J, Xynos E (2021) Management of the adenocarcinoma of the upper rectum: a reappraisal. Updates Surg 73(2):513–526. https://doi.org/10.1007/s13304-020-00903-6CrossRefPubMed

20.

Van Wickle JD, Paulson ES, Landry JC, Erickson BA, Hall WA (2017) Adaptive radiation dose escalation in rectal adenocarcinoma: a review. J Gastrointest Oncol 8(5):902–914. https://doi.org/10.21037/jgo.2017.07.06CrossRefPubMedPubMedCentral

21.

Caravatta L, Lupattelli M, Mantello G, Gambacorta MA, Chiloiro G, di Tommaso M, Rosa C, Gasparini L, Morganti AG, Picardi V, Niespolo RM, Osti MF, Montrone S, Simoni N, Boso C, Facchin F, Deidda MA, Piva C, Guida C, Ziccarelli L, Munoz F, Ivaldi GB, Marchetti V, Franzone P, Spatola C, Franco P, Donato V, Genovesi D, Gastrointestinal Study Group of A (2021) Treatment volume, dose prescription and delivery techniques for dose-intensification in rectal cancer: a national survey. Anticancer Res 41(4):1985–1995. https://doi.org/10.21873/anticanres.14966CrossRefPubMed

22.

Sun Z, Adam MA, Kim J, Czito B, Mantyh C, Migaly J (2017) Intensity-modulated radiation therapy is not associated with perioperative or survival benefit over 3D-conformal radiotherapy for rectal cancer. J Gastrointest Surg 21(1):106–111CrossRef

Title: Neoadjuvant chemoradiotherapy for locally advanced rectal cancer with peritumoral abscesses and fistulas
Authors: Sergey Gordeyev
Valerii Ivanov
Mikhail Fedianin
Marina Chernikh
Nikolay Kozlov
Leonid Petrov
Dmitriy Erygin
Ivan Gridasov
Valery Kaushanskiy
Dmitry Feoktistov
Zaman Mamedli
Publication date: 01-02-2022
Publisher: Springer Berlin Heidelberg
Keywords: Rectal Cancer
Rectal Cancer
Published in: Strahlentherapie und Onkologie / Issue 2/2022
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-021-01878-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Neoadjuvant chemoradiotherapy for locally advanced rectal cancer with peritumoral abscesses and fistulas

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2022

Patterns of care analysis for salivary gland cancer: a survey within the German Society of Radiation Oncology (DEGRO) and recommendations for daily practice

Adjuvant chemoradiotherapy in elderly patients with head and neck cancer: a monoinstitutional, two-to-one pair-matching analysis

The value of brachytherapy in the age of advanced external beam radiotherapy: a review of the literature in terms of dosimetry

12 × 6 Gy stereotactic radiotherapy for lung tumors. Is there a difference in response between lung metastases and primary bronchial carcinoma?

Kardiale stereotaktische Strahlentherapie induziert eine Umprogrammierung des elektrischen Reizleitungssystems

The impact of nutritional counseling on thyroid disorders in head and neck cancer patients after (chemo)radiotherapy: results from a prospective interventional trial

12 × 6 Gy stereotactic radiotherapy for lung tumors. Is there a difference in response between lung metastases and primary bronchial carcinoma?