Skip to main content
Top
Published in: Annals of Surgical Oncology 9/2017

Open Access 01-09-2017 | Gastrointestinal Oncology

Short-Course Radiotherapy Followed by Neoadjuvant Bevacizumab, Capecitabine, and Oxaliplatin and Subsequent Radical Treatment in Primary Stage IV Rectal Cancer: Long-Term Results of a Phase II Study

Authors: C. Bisschop, MD, T. H. van Dijk, MD, J. C. Beukema, MD, R. L. H. Jansen, MD, PhD, H. Gelderblom, MD, PhD, K. P. de Jong, MD, PhD, H. J. T. Rutten, MD, PhD, C. J. H. van de Velde, MD, PhD, T. Wiggers, MD, PhD, K. Havenga, MD, PhD, G. A. P. Hospers, MD, PhD

Published in: Annals of Surgical Oncology | Issue 9/2017

Login to get access

Abstract

Background

In a Dutch phase II trial conducted between 2006 and 2010, short-course radiotherapy followed by systemic therapy with capecitabine, oxaliplatin, and bevacizumab as neoadjuvant treatment and subsequent radical surgical treatment of primary tumor and metastatic sites was evaluated. In this study, we report the long-term results after a minimum follow-up of 6 years.

Methods

Patients with histologically confirmed rectal adenocarcinoma with potentially resectable or ablatable metastases in liver or lungs were eligible. Follow-up data were collected for all patients enrolled in the trial. Overall and recurrence-free survival were calculated using the Kaplan–Meier method.

Results

Follow-up data were available for all 50 patients. After a median follow-up time of 8.1 years (range 6.0–9.8), 16 patients (32.0%) were still alive and 14 (28%) were disease-free. The median overall survival was 3.8 years (range 0.5–9.4). From the 36 patients who received radical treatment, two (5.6%) had a local recurrence and 29 (80.6%) had a distant recurrence.

Conclusions

Long-term survival can be achieved in patients with primary metastatic rectal cancer after neoadjuvant radio- and chemotherapy. Despite a high number of recurrences, 32% of patients were alive after a median follow-up time of 8.1 years.
Literature
1.
2.
go back to reference Leporrier J, Maurel J, Chiche L, Bara S, Segol P, Launoy G. A population-based study of the incidence, management and prognosis of hepatic metastases from colorectal cancer. Br J Surg. 2006;93(4):465–74.CrossRefPubMed Leporrier J, Maurel J, Chiche L, Bara S, Segol P, Launoy G. A population-based study of the incidence, management and prognosis of hepatic metastases from colorectal cancer. Br J Surg. 2006;93(4):465–74.CrossRefPubMed
3.
go back to reference Lemmens VE, de Haan N, Rutten HJ, et al. Improvements in population-based survival of patients presenting with metastatic rectal cancer in the south of the Netherlands, 1992–2008. Clin Exp Metastasis. 2011;28(3):283–90.CrossRefPubMedPubMedCentral Lemmens VE, de Haan N, Rutten HJ, et al. Improvements in population-based survival of patients presenting with metastatic rectal cancer in the south of the Netherlands, 1992–2008. Clin Exp Metastasis. 2011;28(3):283–90.CrossRefPubMedPubMedCentral
4.
go back to reference Gerard 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(28):4620–25.CrossRefPubMed Gerard 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(28):4620–25.CrossRefPubMed
5.
go back to reference Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351(17):1731–40.CrossRefPubMed Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351(17):1731–40.CrossRefPubMed
6.
go back to reference Van Dijk TH, Tamas K, Beukema JC, et al. Evaluation of short-course radiotherapy followed by neoadjuvant bevacizumab, capecitabine, and oxaliplatin and subsequent radical surgical treatment in primary stage IV rectal cancer. Ann Oncol. 2013;24(7):1762–69.CrossRefPubMed Van Dijk TH, Tamas K, Beukema JC, et al. Evaluation of short-course radiotherapy followed by neoadjuvant bevacizumab, capecitabine, and oxaliplatin and subsequent radical surgical treatment in primary stage IV rectal cancer. Ann Oncol. 2013;24(7):1762–69.CrossRefPubMed
7.
go back to reference Czito BG, Bendell JC, Willett CG, et al. Bevacizumab, oxaliplatin, and capecitabine with radiation therapy in rectal cancer: phase I trial results. Int J Radiat Oncol Biol Phys. 2007;68(2):472–78.CrossRefPubMed Czito BG, Bendell JC, Willett CG, et al. Bevacizumab, oxaliplatin, and capecitabine with radiation therapy in rectal cancer: phase I trial results. Int J Radiat Oncol Biol Phys. 2007;68(2):472–78.CrossRefPubMed
8.
go back to reference Dipetrillo T, Pricolo V, Lagares-Garcia J, et al. Neoadjuvant bevacizumab, oxaliplatin, 5-fluorouracil, and radiation for rectal cancer. Int J Radiat Oncol Biol Phys. 2012;82(1):124–29.CrossRefPubMed Dipetrillo T, Pricolo V, Lagares-Garcia J, et al. Neoadjuvant bevacizumab, oxaliplatin, 5-fluorouracil, and radiation for rectal cancer. Int J Radiat Oncol Biol Phys. 2012;82(1):124–29.CrossRefPubMed
9.
go back to reference Mandard AM, Dalibard F, Mandard JC, et al. Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Clinicopathologic correlations. Cancer. 1994;73(11):2680–86.CrossRefPubMed Mandard AM, Dalibard F, Mandard JC, et al. Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Clinicopathologic correlations. Cancer. 1994;73(11):2680–86.CrossRefPubMed
10.
go back to reference Tsai MS, Su YH, Ho MC, et al. Clinicopathological features and prognosis in resectable synchronous and metachronous colorectal liver metastasis. Ann Surg Oncol. 2007;14(2):786–94.CrossRefPubMed Tsai MS, Su YH, Ho MC, et al. Clinicopathological features and prognosis in resectable synchronous and metachronous colorectal liver metastasis. Ann Surg Oncol. 2007;14(2):786–94.CrossRefPubMed
11.
go back to reference Yoon HI, Koom WS, Kim TH, et al. Upfront systemic chemotherapy and short-course radiotherapy with delayed surgery for locally advanced rectal cancer with distant metastases: Outcomes, compliance, and favorable prognostic factors. PLoS ONE. 2016;11(8):e0161475.CrossRefPubMedPubMedCentral Yoon HI, Koom WS, Kim TH, et al. Upfront systemic chemotherapy and short-course radiotherapy with delayed surgery for locally advanced rectal cancer with distant metastases: Outcomes, compliance, and favorable prognostic factors. PLoS ONE. 2016;11(8):e0161475.CrossRefPubMedPubMedCentral
12.
go back to reference Van der Pool AE, de Wilt JH, Lalmahomed ZS, Eggermont AM, Ijzermans JN, Verhoef C. Optimizing the outcome of surgery in patients with rectal cancer and synchronous liver metastases. Br J Surg. 2010;97(3):383–90.CrossRefPubMed Van der Pool AE, de Wilt JH, Lalmahomed ZS, Eggermont AM, Ijzermans JN, Verhoef C. Optimizing the outcome of surgery in patients with rectal cancer and synchronous liver metastases. Br J Surg. 2010;97(3):383–90.CrossRefPubMed
13.
go back to reference Cellini C, Hunt SR, Fleshman JW, Birnbaum EH, Bierhals AJ, Mutch MG. Stage IV rectal cancer with liver metastases: Is there a benefit to resection of the primary tumor? World J Surg. 2010;34(5):1102–08.CrossRefPubMed Cellini C, Hunt SR, Fleshman JW, Birnbaum EH, Bierhals AJ, Mutch MG. Stage IV rectal cancer with liver metastases: Is there a benefit to resection of the primary tumor? World J Surg. 2010;34(5):1102–08.CrossRefPubMed
14.
go back to reference Ayez N, Burger JW, van der Pool AE, et al. Long-term results of the “liver first” approach in patients with locally advanced rectal cancer and synchronous liver metastases. Dis Colon Rectum. 2013;56(3):281–87.CrossRefPubMed Ayez N, Burger JW, van der Pool AE, et al. Long-term results of the “liver first” approach in patients with locally advanced rectal cancer and synchronous liver metastases. Dis Colon Rectum. 2013;56(3):281–87.CrossRefPubMed
15.
go back to reference Pinto C, Pini S, Di Fabio F, et al. Treatment strategy for rectal cancer with synchronous metastasis: 65 consecutive italian cases from the bologna multidisciplinary rectal cancer group. Oncology. 2014;86(3):135–42.CrossRefPubMed Pinto C, Pini S, Di Fabio F, et al. Treatment strategy for rectal cancer with synchronous metastasis: 65 consecutive italian cases from the bologna multidisciplinary rectal cancer group. Oncology. 2014;86(3):135–42.CrossRefPubMed
16.
go back to reference Butte JM, Gonen M, Ding P, et al. Patterns of failure in patients with early onset (synchronous) resectable liver metastases from rectal cancer. Cancer. 2012;118(21):5414–23.CrossRefPubMed Butte JM, Gonen M, Ding P, et al. Patterns of failure in patients with early onset (synchronous) resectable liver metastases from rectal cancer. Cancer. 2012;118(21):5414–23.CrossRefPubMed
17.
go back to reference Wiering B, Krabbe PF, Jager GJ, Oyen WJ, Ruers TJ. The impact of fluor-18-deoxyglucose-positron emission tomography in the management of colorectal liver metastases. Cancer. 2005;104(12):2658–70.CrossRefPubMed Wiering B, Krabbe PF, Jager GJ, Oyen WJ, Ruers TJ. The impact of fluor-18-deoxyglucose-positron emission tomography in the management of colorectal liver metastases. Cancer. 2005;104(12):2658–70.CrossRefPubMed
18.
go back to reference Ruers TJ, Wiering B, van der Sijp JR, et al. Improved selection of patients for hepatic surgery of colorectal liver metastases with (18)F-FDG PET: a randomized study. J Nucl Med. 2009;50(7):1036–41.CrossRefPubMed Ruers TJ, Wiering B, van der Sijp JR, et al. Improved selection of patients for hepatic surgery of colorectal liver metastases with (18)F-FDG PET: a randomized study. J Nucl Med. 2009;50(7):1036–41.CrossRefPubMed
19.
go back to reference Hof J, Wertenbroek MW, Peeters PM, Widder J, Sieders E, De Jong KP. Outcomes after resection and/or radiofrequency ablation for recurrence after treatment of colorectal liver metastases. Br J Surg. 2016;103(8):1055–62.CrossRefPubMed Hof J, Wertenbroek MW, Peeters PM, Widder J, Sieders E, De Jong KP. Outcomes after resection and/or radiofrequency ablation for recurrence after treatment of colorectal liver metastases. Br J Surg. 2016;103(8):1055–62.CrossRefPubMed
20.
go back to reference Manceau G, Brouquet A, Bachet JB, et al. Response of liver metastases to preoperative radiochemotherapy in patients with locally advanced rectal cancer and resectable synchronous liver metastases. Surgery. 2013;154(3):528–35.CrossRefPubMed Manceau G, Brouquet A, Bachet JB, et al. Response of liver metastases to preoperative radiochemotherapy in patients with locally advanced rectal cancer and resectable synchronous liver metastases. Surgery. 2013;154(3):528–35.CrossRefPubMed
21.
go back to reference Lam VW, Spiro C, Laurence JM, et al. A systematic review of clinical response and survival outcomes of downsizing systemic chemotherapy and rescue liver surgery in patients with initially unresectable colorectal liver metastases. Ann Surg Oncol. 2012;19(4):1292–1301.CrossRefPubMed Lam VW, Spiro C, Laurence JM, et al. A systematic review of clinical response and survival outcomes of downsizing systemic chemotherapy and rescue liver surgery in patients with initially unresectable colorectal liver metastases. Ann Surg Oncol. 2012;19(4):1292–1301.CrossRefPubMed
22.
go back to reference Tyc-Szczepaniak D, Wyrwicz L, Kepka L. Palliative radiotherapy and chemotherapy instead of surgery in symptomatic rectal cancer with synchronous unresectable metastases: a phase II study. Ann Oncol. 2013;24(11):2829–34.CrossRefPubMed Tyc-Szczepaniak D, Wyrwicz L, Kepka L. Palliative radiotherapy and chemotherapy instead of surgery in symptomatic rectal cancer with synchronous unresectable metastases: a phase II study. Ann Oncol. 2013;24(11):2829–34.CrossRefPubMed
23.
go back to reference Tyc-Szczepaniak D, Wyrwicz L, Wiśniowska K, Michalski W, Pietrzak L, Bujko K. Palliative radiotherapy and chemotherapy instead of surgery in symptomatic rectal cancer with synchronous unresectable metastases: long-term results of a phase II study. Acta Oncol. 2016;55(11):1369–70.CrossRefPubMed Tyc-Szczepaniak D, Wyrwicz L, Wiśniowska K, Michalski W, Pietrzak L, Bujko K. Palliative radiotherapy and chemotherapy instead of surgery in symptomatic rectal cancer with synchronous unresectable metastases: long-term results of a phase II study. Acta Oncol. 2016;55(11):1369–70.CrossRefPubMed
24.
go back to reference Garrer WY, Hossieny HA, Gad ZS, et al. Appropriate timing of surgery after neoadjuvant chemoradiation therapy for locally advanced rectal cancer. Asian Pac J Cancer Prev. 2016;17(9):4381–89.PubMed Garrer WY, Hossieny HA, Gad ZS, et al. Appropriate timing of surgery after neoadjuvant chemoradiation therapy for locally advanced rectal cancer. Asian Pac J Cancer Prev. 2016;17(9):4381–89.PubMed
25.
go back to reference Silberhumer GR, Paty PB, Temple LK, et al. Simultaneous resection for rectal cancer with synchronous liver metastasis is a safe procedure. Am J Surg. 2015;209(6):935–42.CrossRefPubMed Silberhumer GR, Paty PB, Temple LK, et al. Simultaneous resection for rectal cancer with synchronous liver metastasis is a safe procedure. Am J Surg. 2015;209(6):935–42.CrossRefPubMed
26.
go back to reference Paun BC, Cassie S, MacLean AR, Dixon E, Buie WD. Postoperative complications following surgery for rectal cancer. Ann Surg. 2010;251(5):807–18.CrossRefPubMed Paun BC, Cassie S, MacLean AR, Dixon E, Buie WD. Postoperative complications following surgery for rectal cancer. Ann Surg. 2010;251(5):807–18.CrossRefPubMed
27.
go back to reference Doci R, Gennari L, Bignami P, et al. Morbidity and mortality after hepatic resection of metastases from colorectal cancer. Br J Surg. 1995;82(3):377–81.CrossRefPubMed Doci R, Gennari L, Bignami P, et al. Morbidity and mortality after hepatic resection of metastases from colorectal cancer. Br J Surg. 1995;82(3):377–81.CrossRefPubMed
Metadata
Title
Short-Course Radiotherapy Followed by Neoadjuvant Bevacizumab, Capecitabine, and Oxaliplatin and Subsequent Radical Treatment in Primary Stage IV Rectal Cancer: Long-Term Results of a Phase II Study
Authors
C. Bisschop, MD
T. H. van Dijk, MD
J. C. Beukema, MD
R. L. H. Jansen, MD, PhD
H. Gelderblom, MD, PhD
K. P. de Jong, MD, PhD
H. J. T. Rutten, MD, PhD
C. J. H. van de Velde, MD, PhD
T. Wiggers, MD, PhD
K. Havenga, MD, PhD
G. A. P. Hospers, MD, PhD
Publication date
01-09-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 9/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-017-5897-0

Other articles of this Issue 9/2017

Annals of Surgical Oncology 9/2017 Go to the issue