Ann Surg Treat Res.  2017 Apr;92(4):200-207. 10.4174/astr.2017.92.4.200.

Matched case-control analysis comparing oncologic outcomes between preoperative and postoperative chemoradiotherapy for rectal cancer

• Lee BC
• Park IJ
• Kim CW
• Lim SB
• Yu CS
• Kim JC

• KMID: 2374685
• DOI: http://doi.org/10.4174/astr.2017.92.4.200

Abstract

PURPOSE
To investigate patterns of recurrence and oncologic outcomes after recurrence between preoperative and postoperative chemoradiotherapy (CRT).
METHODS
Records of patients with stage II or III locally advanced rectal cancer seen between January 2000 and December 2010 were analyzed. The outcomes for patients undergoing preoperative CRT followed by radical resection (n = 466) were compared with outcomes of patients matched for sex, age, and stage who had surgery and then postoperative CRT (n = 466). Recurrence rates and sites, treatment of recurrence, and oncologic outcomes after recurrence were investigated. The rate of sphincter preservation and permanent stoma formation were also evaluated.
RESULTS
Recurrence occurred in 124 and 140 patients in the pre- and postoperative CRT groups, respectively. The local and systemic recurrence rates were 3.6% and 20.8%, respectively, in the preoperative CRT group and 3.0% and 25.3%, respectively, in the postoperative CRT group (P = 0.245). Time to recurrence was longer in the postoperative CRT group (19 months vs. 24.2 months, P = 0.029). The overall rates of sphincter preservation (sphincter preservation operation and postoperative permanent stoma formation) did not significantly different between the two groups (P = 0.381). The 5-year overall survival rate after recurrence did not differ between the two groups (25.6% vs. 18.6%, P = 0.051).
CONCLUSION
Preoperative and postoperative CRT are both safe and suitable treatment methods for rectal cancer, so the choice can be tailored to the patient's situation.

Keyword

Chemoradiotherapy; Colorectal surgery; Rectal neoplasms; Recurrence; Treatment outcome

MeSH Terms

Case-Control Studies*
Chemoradiotherapy*
Colorectal Surgery
Humans
Rectal Neoplasms*
Recurrence
Survival Rate
Treatment Outcome

Figure

• 

  Fig. 1 Pattern and treatment of recurrences of rectal cancer. CRT, chemoradiotherapy; Op, operation; SBRT, stereotactic body radiotherapy; RFA, radiofrequency ablation; CTx, chemotherapy; BSC, best supportive care; LN, lymph node; PS, peritoneal seeding.

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  Fig. 2 (A) Overall survival (OS) in pre- and postoperative chemoradiotherapy (CRT) groups. (B) Overall survival after recurrence in the pre- and postoperative CRT groups.

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