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
Radiation Oncology
Published in: Radiation Oncology 1/2014

Open Access 01-12-2014 | Research

Sphincter preservation in distal CT2N0 rectal cancer after preoperative chemoradiotherapy

Authors: Nir Wasserberg, Yulia Kundel, Ofer Purim, Andrei Keidar, Hanoch Kashtan, Eran Sadot, Eyal Fenig, Baruch Brenner

Published in: Radiation Oncology | Issue 1/2014

Login to get access

Abstract

Background

Preoperative chemoradiotherapy is usually not indicated for cT2N0 rectal cancer. Abdominoperineal resection is the standard treatment for distal rectal tumors. The aim of the study was to evaluate the actual sphincter-preservation rate in patients with distal cT2N0 rectal cancer given neoadjuvant chemoradiotherapy.

Methods

Data were retrospectively collected for all patients who were diagnosed with distal cT2N0 rectal cancer at a tertiary medical center in 2000-2008 and received chemoradiotherapy followed by surgery (5-7 weeks later).

Results

Thirty-three patients (22 male) of median age 65 years (range, 32-88) were identified. Tumor distance from the anal verge ranged from 0 to 5 cm. R0 resection with sphincter preservation was accomplished in 22 patients (66%), with a 22% pathological complete response rate. Median follow-up time was 62 months (range 7-120). There were no local failures. Crude disease-free and overall survival were 82% and 86%, respectively. Factors associated with sphincter preservation were tumor location (OR = 0.58, p =0.02, 95% CI = 0.37-0.91) and pathological downstaging (OR = 7.8, p = 0.02, 95% CI = 1.35-45.85). Chemoradiotherapy was well tolerated.

Conclusion

High rates of sphincter preservation can be achieved after preoperative chemoradiotherapy for distal cT2N0 rectal cancer, with tolerable toxicity, without compromising oncological outcome.
Appendix
Available only for authorised users
Literature
1.
Wasserberg N, Gutman H: Resection margins in modern rectal cancer surgery. J Surg Oncol. 2008, 98: 611-615. 10.1002/jso.21036.CrossRefPubMed
2.
Chessin DB, Guillem JG: Abdominoperineal resection for rectal cancer: historic perspective and current issues. Surg Oncol Clin N Am. 2005, 14: 569-586. 10.1016/j.soc.2005.04.002. viiCrossRefPubMed
3.
Nissan A, Guillem JG, Paty PB, Douglas Wong W, Minsky B, Saltz L, Cohen AM: Abdominoperineal resection for rectal cancer at a specialty center. Dis Colon Rectum. 2001, 44: 27-36. 10.1007/BF02234816.CrossRefPubMed
4.
Tytherleigh MG, Warren BF, Mortensen NJ: Management of early rectal cancer. Br J Surg. 2008, 95: 409-423. 10.1002/bjs.6127.CrossRefPubMed
5.
Dahlberg M, Glimelius B, Påhlman L: Improved survival and reduction in local failure rates after preoperative radiotherapy: evidence for the generalizability of the results of Swedish Rectal Cancer Trial. Ann Surg. 1999, 229: 493-497. 10.1097/00000658-199904000-00007.PubMedCentralCrossRefPubMed
6.
Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, Martus P, Tschmelitsch J, Hager E, Hess CF, Karstens JH, Liersch T, Schmidberger H, Raab R: Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004, 351: 1731-1740. 10.1056/NEJMoa040694.CrossRefPubMed
7.
Ferenschild FT, Dawson I, de Graaf EJ, de Wilt JH, Tetteroo GW: Preoperative radiotherapy has no value for patients with T2-3, N0 adenocarcinomas of the rectum. Dig Surg. 2009, 26: 291-296. 10.1159/000227771.CrossRefPubMed
8.
Tsai BM, Finne CO, Nordenstam JF, Christoforidis D, Madoff RD, Mellgren A: Transanal endoscopic microsurgery resection of rectal tumors: outcomes and recommendations. Dis Colon Rectum. 2010, 53: 16-23. 10.1007/DCR.0b013e3181bbd6ee.CrossRefPubMed
9.
Crane CH, Skibber JM, Birnbaum EH, Feig BW, Singh AK, Delclos ME, Lin EH, Fleshman JW, Thames HD, Kodner IJ, Lockett MA, Picus J, Phan T, Chandra A, Janjan NA, Read TE, Myerson RJ: The addition of continuous infusion 5-FU to preoperative radiation therapy increases tumor response, leading to increased sphincter preservation in locally advanced rectal cancer. Int J Radiat Oncol Biol Phys. 2003, 57: 84-89. 10.1016/S0360-3016(03)00532-7.CrossRefPubMed
10.
Crane CH, Skibber JM, Feig BW, Vauthey JN, Thames HD, Curley SA, Rodriguez-Bigas MA, Wolff RA, Ellis LM, Delclos ME, Lin EH, Janjan NA: Response to preoperative chemoradiation increases the use of sphincter-preserving surgery in patients with locally advanced low rectal carcinoma. Cancer. 2003, 97: 517-524. 10.1002/cncr.11075.CrossRefPubMed
11.
Rengan R, Paty P, Wong WD, Guillem J, Weiser M, Temple L, Saltz L, Minsky BD: Distal cT2N0 rectal cancer: is there an alternative to abdominoperineal resection?. J Clin Oncol. 2005, 23: 4905-4912. 10.1200/JCO.2005.10.041.CrossRefPubMed
12.
Kim DW, Lim SB, Kim DY, Kim TH, Jung KH, Kim DH, Chang HJ, Sohn DK, Hong CW, Choi HS, Jeong SY, Park JG: Pre-operative chemo-radiotherapy improves the sphincter preservation rate in patients with rectal cancer located within 3 cm of the anal verge. Eur J Surg Oncol. 2006, 32: 162-167. 10.1016/j.ejso.2005.10.002.CrossRefPubMed
13.
Francois Y, Nemoz CJ, Baulieux J, Francois Y, Nemoz CJ, Baulieux J: Influence of the interval between preoperative radiation therapy and surgery on downstaging and on the rate of sphincter-sparing surgery for rectal cancer: the Lyon R90-01 randomized trial. J Clin Oncol. 1999, 17: 2396-PubMed
14.
Bujko K, Nowacki MP, Nasierowska-Guttmejer A, Michalski W, Bebenek M, Pudełko M, Kryj M, Oledzki J, Szmeja J, Słuszniak J, Serkies K, Kładny J, Pamucka M, Kukołowicz P: Sphincter preservation following preoperative radiotherapy for rectal cancer: report of a randomised trial comparing short-term radiotherapy vs. conventionally fractionated radiochemotherapy. Radiother Oncol. 2004, 72: 15-24. 10.1016/j.radonc.2003.12.006.CrossRefPubMed
15.
Bujko K, Kepka L, Michalski W, Nowacki MP: Does rectal cancer shrinkage induced by preoperative radio(chemo)therapy increase the likelihood of anterior resection? A systematic review of randomised trials. Radiother Oncol. 2006, 80: 4-12. 10.1016/j.radonc.2006.04.012.CrossRefPubMed
16.
Rouanet P, Saint-Aubert B, Lemanski C, Senesse P, Gourgou S, Quenet F, Ycholu M, Kramar A, Dubois J: Restorative and nonrestorative surgery for low rectal cancer after high-dose radiation: long-term oncologic and functional results. Dis Colon Rectum. 2002, 45: 305-313. 10.1007/s10350-004-6172-6. discussion 313-331CrossRefPubMed
17.
Gonzalez QH, Heslin MJ, Shore G, Vickers SM, Urist MM, Bland KI: Results of long-term follow-up for transanal excision for rectal cancer. Am Surg. 2003, 69: 675-678.PubMed
18.
Temple LK, Romanus D, Niland J, Veer AT, Weiser MR, Skibber J, Wilson J, Rajput A, Benson A, Wong YN, Schrag D: Factors associated with sphincter-preserving surgery for rectal cancer at national comprehensive cancer network centers. Ann Surg. 2009, 250: 260-267. 10.1097/SLA.0b013e3181ae330e.CrossRefPubMed
19.
Kong M, Hong SE, Choi WS, Kim SY, Choi J: Preoperative concurrent chemoradiotherapy for locally advanced rectal cancer: treatment outcomes and analysis of prognostic factors. Cancer Res Treat. 2012, 44: 104-112. 10.4143/crt.2012.44.2.104.PubMedCentralCrossRefPubMed
20.
Howard JH, Gonzalez Q, Arnoletti JP, Russo S, Fiveash JB, Bland KI, Heslin MJ: Prognostic factors and preoperative radiation therapy associated with sphincter preservation in patients with resectable rectal cancer. Am J Surg. 2008, 195: 239-243. 10.1016/j.amjsurg.2007.03.011.CrossRefPubMed
21.
Habr-Gama A, Perez RO, Proscurshim I, Campos FG, Nadalin W, Kiss D, Gama-Rodrigues J: Patterns of failure and survival for nonoperative treatment of stage c0 distal rectal cancer following neoadjuvant chemoradiation therapy. J Gastrointest Surg. 2006, 10: 1319-1328. 10.1016/j.gassur.2006.09.005.CrossRefPubMed
22.
Habr-Gama A, Perez R, Proscurshim I, Gama-Rodrigues J: Complete clinical response after neoadjuvant chemoradiation for distal rectal cancer. Surg Oncol Clin N Am. 2010, 19: 829-845. 10.1016/j.soc.2010.08.001.CrossRefPubMed
23.
Marijnen CA, van de Velde CJ, Putter H, van den Brink M, Maas CP, Martijn H, Rutten HJ, Wiggers T, Kranenbarg EK, Leer JW, Stiggelbout AM: Impact of short-term preoperative radiotherapy on health-related quality of life and sexual functioning in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol. 2005, 23: 1847-1858. 10.1200/JCO.2005.05.256.CrossRefPubMed
24.
Peeters KC, van de Velde CJ, Leer JW, Martijn H, Junggeburt JM, Kranenbarg EK, Steup WH, Wiggers T, Rutten HJ, Marijnen CA: Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients-a Dutch colorectal cancer group study. J Clin Oncol. 2005, 23: 6199-6206. 10.1200/JCO.2005.14.779.CrossRefPubMed
25.
Valentini V, Glimelius B, Minsky BD, Van Cutsem E, Bartelink H, Beets-Tan RG, Gerard JP, Kosmidis P, Pahlman L, Picciocchi A, Quirke P, Tepper J, Tonato M, Van de Velde CJ, Cellini N, Latini P: The multidisciplinary rectal cancer treatment: main convergences, controversial aspects and investigational areas which support the need for an European Consensus. Radiother Oncol. 2005, 76: 241-250. 10.1016/j.radonc.2005.07.001.CrossRefPubMed
26.
Dahlberg M, Glimelius B, Graf W, Påhlman L: Preoperative irradiation affects functional results after surgery for rectal cancer: results from a randomized study. Dis Colon Rectum. 1998, 41: 543-549. 10.1007/BF02235256.CrossRefPubMed
27.
Temple LK, Bacik J, Savatta SG, Gottesman L, Paty PB, Weiser MR, Guillem JG, Minsky BD, Kalman M, Thaler HT, Schrag D, Wong WD: The development of a validated instrument to evaluate bowel function after sphincter-preserving surgery for rectal cancer. Dis Colon Rectum. 2005, 48: 1353-1365. 10.1007/s10350-004-0942-z.CrossRefPubMed
28.
Goldstein NS: Lymph node recoveries from 2427 pT3 colorectal resection specimens spanning 45 years: recommendations for a minimum number of recovered lymph nodes based on predictive probabilities. Am J Surg Pathol. 2002, 26 (2): 179-189. 10.1097/00000478-200202000-00004.CrossRefPubMed
29.
Kim YW, Kim NK, Min BS, Lee KY, Sohn SK, Cho CH: The influence of the number of retrieved lymph nodes on staging and survival in patients with stage II and III rectal cancer undergoing tumor-specific mesorectal excision. Ann Surg. 2009, 249: 965-972. 10.1097/SLA.0b013e3181a6cc25.CrossRefPubMed
30.
Sobin LH: TNM classification: clarification of number of regional lymph nodes for pN0. Br J Cancer. 2001, 85: 780-10.1054/bjoc.2001.1996.CrossRefPubMed
31.
Rinkus KM, Russell GB, Levine EA: Prognostic significance of nodal disease following preoperative radiation for rectal adenocarcinoma. Am Surg. 2002, 68: 482-487. vPubMed
32.
Kim YW, Kim NK, Min BS, Lee KY, Sohn SK, Cho CH, Kim H, Keum KC, Ahn JB: The prognostic impact of the number of lymph nodes retrieved after neoadjuvant chemoradiotherapy with mesorectal excision for rectal cancer. J Surg Oncol. 2009, 100: 1-7. 10.1002/jso.21299.CrossRefPubMed
Metadata
Title
Sphincter preservation in distal CT2N0 rectal cancer after preoperative chemoradiotherapy
Authors
Nir Wasserberg
Yulia Kundel
Ofer Purim
Andrei Keidar
Hanoch Kashtan
Eran Sadot
Eyal Fenig
Baruch Brenner
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2014
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/s13014-014-0233-3

Other articles of this Issue 1/2014

Radiation Oncology 1/2014 Go to the issue

Methodology

Concept for individualized patient allocation: ReCompare—remote comparison of particle and photon treatment plans

Research

Clinical outcome of postoperative highly conformal versus 3D conformal radiotherapy in patients with malignant pleural mesothelioma

Research

Critical appraisal of RapidArc radiosurgery with flattening filter free photon beams for benign brain lesions in comparison to GammaKnife: a treatment planning study

Research

Repeated stereotactic body radiotherapy for oligometastatic prostate cancer recurrence

Research

RAD9 deficiency enhances radiation induced bystander DNA damage and transcriptomal response

Short report

Short communication: timeline of radiation-induced kidney function loss after stereotactic ablative body radiotherapy of renal cell carcinoma as evaluated by serial 99mTc-DMSA SPECT/CT