Cancer Res Treat.  2018 Jul;50(3):1039-1050. 10.4143/crt.2017.252.

The Impact of Surgical Timing on Pathologic Tumor Response after Short Course and Long Course Preoperative Chemoradiation for Locally Advanced Rectal Adenocarcinoma

Affiliations
  • 1Department of Radiation Oncology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. hsjang11@catholic.ac.kr
  • 2Department of Radiation Oncology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 3Department of Colorectal Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 4Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
  • 5Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 6Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 7Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.
  • 8Department of Radiation Oncology, Chonnam National University Medical School, Gwangju, Korea.

Abstract

PURPOSE
A pooled analysis of multi-institutional trials was performed to analyze the effect of surgical timing on tumor response by comparing short course concurrent chemoradiotherapy (CCRT) with long course CCRT followed by delayed surgery in locally advanced rectal cancer.
MATERIALS AND METHODS
Three hundred patients with cT3-4N0-2 rectal adenocarcinoma were included. Long course patients from KROG 14-12 (n=150) were matched 1:1 to 150 short course patients from KROG 10-01 (NCT01129700) and KROG 11-02 (NCT01431599) according to stage, age, and other risk factors. The primary endpoint was to determine the interval between surgery and the last day of neoadjuvant CCRT which yields the best tumor response after the short course and long course CCRT. Downstaging was defined as ypT0-2N0M0 and pathologic complete response (ypCR) was defined as ypT0N0M0, respectively.
RESULTS
Both the long and short course groups achieved lowest downstaging rates at < 6 weeks (long 20% vs. short 8%) and highest downstaging rates at 6-7 weeks (long 44% vs. short 40%). The ypCR rates were lowest at < 6 weeks (both long and short 0%) and highest at 6-7 weeks (long 21% vs. short 11%) in both the short and long course arms. The downstaging and ypCR rates of long course group gradually declined after the peak at 6-7 weeks and those of the short course group trend to constantly increase afterwards.
CONCLUSION
It is optimal to perform surgery at least 6 weeks after both the short course and long course CCRT to obtain maximal tumor regression in locally advanced rectal adenocarcinoma.

Keyword

Rectal neoplasms; Chemoradiotherapy; Surgery interval

MeSH Terms

Adenocarcinoma*
Arm
Chemoradiotherapy
Humans
Rectal Neoplasms
Risk Factors

Figure

  • Fig. 1. Distribution of downstaging rates by weeks since completion of radiotherapy to surgery in short course and long course patients.

  • Fig. 2. Distribution of pathologic complete response (ypCR) rates by weeks since completion of radiotherapy to surgery in short course and long course patients.

  • Fig. 3. A hypothesis of radiobiology behind the difference in distribution of pathologic complete response (ypCR) rates by weeks since completion of radiotherapy to surgery in short course and long course chemoradiation.


Reference

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