Trends and outcome of neoadjuvant treatment for rectal cancer: A retrospective analysis and critical assessment of a 10-year prospective national registry on behalf of the Spanish Rectal Cancer Project

Pellino, G.; Quintana, N.U.; Bollo, J.; Blanco Gonzalez, F.J.; Lujan Mompean, J.A.; Flores, L.; Calvo, A.P.; Lara, M.L.; García-Granero, E.; Cid, R.C.; Benítez, F.P.; Capitán Morales, L.C.; Codina-Cazador, A.; Díaz Pavón, J.M.; Díaz, O.M.; Maestre, M.V.; Aceituno, F.R.; Vallribera, F.; Orozco, M.O.; Díaz Mejías, J.G.; Ciga Lozano, M.Á.; García, N.P.; Biondo, S.; Gumbau, V.; Pujol, F.O.; Martínez, E.M.; Carceller, R.A.; Rodrigo del Valle, S.; Pérez García, J.A.; Garcea, A.; Alonso, M.G.; Alegre, J.M.; Ruiz Carmona, M.D.; Botella, M.G.; Pérez, M.R.; Dominguez Tristancho, J.L.; Carazo, P.P.; Roman, M.P.; Macias, A.E.; Abad, J.M.; Sánchez de la Villa, G.; Gil, A.S.; de Miguel Velasco, M.; Cazador, A.C.; Sebastian, A.A.; Hernández, J.V.; Vallejo, A.L.; Gimenez, R.P.; Pascual, V.V.; Alvarado, N.C.; de Dios Franco Osorio, J.; Casanovas, P.H.; Carmona Saez, J.A.; Alonso, E.A.; Múgica Martinera, J.A.; Bernal Sprekelsen, J.C.; Pascual, M.P.; Alós, R.; Villarreal, G.C.; Barbadillo, J.G.; Cotore, J.P.; Roig-Vila, J.V.; Sanchez, T.T.; Cortijo, A.A.; Rodamilans, X.; Estévan, R.E.; García García, J.M.; García Coret, M.J.; Fraccalvieri, D.; Lindenbaum, P.D.; Martin, M.R.; Garijo Alvarez, J.Á.; Alustiza, J.E.; Cervantes, A.; Laredo, A.L.; Schedling, M.M.; García, J.G.; Martínez, J.S.; Olías, M.D.L.V.; Enríquez-Navascues, J.M.; Mirón, B.; Alvarez, D.H.; Blanco, S.; Casajuana, F.L.; Nieto, I.P.; Gutierrez, J.; Gallego, G.M.; Basany, E.E.; Bueno, A.S.; Sierra Grañon, J.E.; Fadrique, A.G.; Nuñez, E.C.; Baños, P.B.; Ais Conde, J.G.; Serrat, D.R.; Espín-Basany, E.; Ausas, I.C.; Idoate, C.P.; Pardavila, R.M.; Solé, R.B.; Trill, J.D.; Morgades, R.R.; Jimenez, I.S.; Tebar, J.C.; Jimenez Miramón, F.J.; Huidobro Piriz, A.M.; Gris, F.; Duarte, Á.R.; Estevez Diz, A.M.; Martinez, M.; Ortiz de Zarate, L.

doi:10.1016/j.ejso.2020.04.056

000106580 001__ 106580
000106580 005__ 20230519145345.0
000106580 0247_ $$2doi$$a10.1016/j.ejso.2020.04.056
000106580 0248_ $$2sideral$$a120256
000106580 037__ $$aART-2021-120256
000106580 041__ $$aeng
000106580 100__ $$aPellino, G.
000106580 245__ $$aTrends and outcome of neoadjuvant treatment for rectal cancer: A retrospective analysis and critical assessment of a 10-year prospective national registry on behalf of the Spanish Rectal Cancer Project
000106580 260__ $$c2021
000106580 5060_ $$aAccess copy available to the general public$$fUnrestricted
000106580 5203_ $$aIntroduction: Preoperative treatment and adequate surgery increase local control in rectal cancer. However, modalities and indications for neoadjuvant treatment may be controversial. Aim of this study was to assess the trends of preoperative treatment and outcomes in patients with rectal cancer included in the Rectal Cancer Registry of the Spanish Associations of Surgeons. 
Method: This is a STROBE-compliant retrospective analysis of a prospective database. All patients operated on with curative intention included in the Rectal Cancer Registry were included. Analyses were performed to compare the use of neoadjuvant/adjuvant treatment in three timeframes: I)2006–2009; II)2010–2013; III)2014–2017. Survival analyses were run for 3-year survival in timeframes I-II. 
Results: Out of 14, 391 patients, 8871 (61.6%) received neoadjuvant treatment. Long-course chemo/radiotherapy was the most used approach (79.9%), followed by short-course radiotherapy ± chemotherapy (7.6%). The use of neoadjuvant treatment for cancer of the upper third (15-11 cm) increased over time (31.5%vs 34.5%vs 38.6%, p = 0.0018). The complete regression rate slightly increased over time (15.6% vs 16% vs 18.5%; p = 0.0093); the proportion of patients with involved circumferential resection margins (CRM) went down from 8.2% to 7.3%and 5.5% (p = 0.0004). Neoadjuvant treatment significantly decreased positive CRM in lower third tumors (OR 0.71, 0.59–0.87, Cochrane-Mantel-Haenszel P = 0.0008). Most ypN0 patients also received adjuvant therapy. In MR-defined stage III patients, preoperative treatment was associated with significantly longer local-recurrence-free survival (p < 0.0001), and cancer-specific survival (p < 0.0001). The survival benefit was smaller in upper third cancers. 
Conclusion: There was an increasing trend and a potential overuse of neoadjuvant treatment in cancer of the upper rectum. Most ypN0 patients received postoperative treatment. Involvement of CRM in lower third tumors was reduced after neoadjuvant treatment. Stage III and MRcN + benefited the most.
000106580 540__ $$9info:eu-repo/semantics/openAccess$$aAll rights reserved$$uhttp://www.europeana.eu/rights/rr-f/
000106580 590__ $$a4.037$$b2021
000106580 591__ $$aSURGERY$$b41 / 214 = 0.192$$c2021$$dQ1$$eT1
000106580 591__ $$aONCOLOGY$$b132 / 245 = 0.539$$c2021$$dQ3$$eT2
000106580 594__ $$a6.2$$b2021
000106580 592__ $$a1.016$$b2021
000106580 593__ $$aSurgery$$c2021$$dQ1
000106580 593__ $$aMedicine (miscellaneous)$$c2021$$dQ1
000106580 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/acceptedVersion
000106580 700__ $$aAlós, R.
000106580 700__ $$aBiondo, S.
000106580 700__ $$aCodina-Cazador, A.
000106580 700__ $$aEnríquez-Navascues, J.M.
000106580 700__ $$aEspín-Basany, E.
000106580 700__ $$aRoig-Vila, J.V.
000106580 700__ $$aCervantes, A.
000106580 700__ $$aGarcía-Granero, E.
000106580 700__ $$aCarceller, R.A.
000106580 700__ $$aAis Conde, J.G.
000106580 700__ $$aAlonso, E.A.
000106580 700__ $$aCortijo, A.A.
000106580 700__ $$aSebastian, A.A.
000106580 700__ $$aBaños, P.B.
000106580 700__ $$aSolé, R.B.
000106580 700__ $$aBernal Sprekelsen, J.C.
000106580 700__ $$aBlanco Gonzalez, F.J.
000106580 700__ $$aBlanco, S.
000106580 700__ $$aBollo, J.
000106580 700__ $$aAlvarado, N.C.
000106580 700__ $$aAusas, I.C.
000106580 700__ $$aCid, R.C.
000106580 700__ $$aCarmona Saez, J.A.
000106580 700__ $$aNuñez, E.C.
000106580 700__ $$aCapitán Morales, L.C.
000106580 700__ $$aVillarreal, G.C.
000106580 700__ $$aTebar, J.C.
000106580 700__ $$aCiga Lozano, M.Á.
000106580 700__ $$aCazador, A.C.
000106580 700__ $$ade Dios Franco Osorio, J.
000106580 700__ $$aOlías, M.D.L.V.
000106580 700__ $$ade Miguel Velasco, M.
000106580 700__ $$aRodrigo del Valle, S.
000106580 700__ $$aDíaz Mejías, J.G.
000106580 700__ $$aDíaz Pavón, J.M.
000106580 700__ $$aTrill, J.D.
000106580 700__ $$aDominguez Tristancho, J.L.
000106580 700__ $$aLindenbaum, P.D.
000106580 700__ $$aAlustiza, J.E.
000106580 700__ $$aMacias, A.E.
000106580 700__ $$aBasany, E.E.
000106580 700__ $$aEstévan, R.E.
000106580 700__ $$aEstevez Diz, A.M.
000106580 700__ $$aFlores, L.
000106580 700__ $$aFraccalvieri, D.
000106580 700__ $$aGarcea, A.
000106580 700__ $$aAlonso, M.G.
000106580 700__ $$aBotella, M.G.
000106580 700__ $$aGarcía Coret, M.J.
000106580 700__ $$aFadrique, A.G.
000106580 700__ $$aGarcía García, J.M.
000106580 700__ $$aGarcía, J.G.
000106580 700__ $$aGarijo Alvarez, J.Á.
000106580 700__ $$aBarbadillo, J.G.
000106580 700__ $$aGris, F.
000106580 700__ $$aGumbau, V.
000106580 700__ $$aGutierrez, J.
000106580 700__ $$aCasanovas, P.H.
000106580 700__ $$aAlvarez, D.H.
000106580 700__ $$aHuidobro Piriz, A.M.
000106580 700__ $$aJimenez Miramón, F.J.
000106580 700__ $$aLaredo, A.L.
000106580 700__ $$aVallejo, A.L.
000106580 700__ $$aCasajuana, F.L.
000106580 700__ $$aLara, M.L.
000106580 700__ $$aLujan Mompean, J.A.
000106580 700__ $$aMaestre, M.V.
000106580 700__ $$aMartínez, E.M.
000106580 700__ $$aMartinez, M.
000106580 700__ $$aAlegre, J.M.
000106580 700__ $$aGallego, G.M.
000106580 700__ $$aPardavila, R.M.
000106580 700__ $$aDíaz, O.M.
000106580 700__ $$aSchedling, M.M.
000106580 700__ $$aMirón, B.
000106580 700__ $$0(orcid)0000-0001-9466-3902$$aAbad, J.M.$$uUniversidad de Zaragoza
000106580 700__ $$aMúgica Martinera, J.A.
000106580 700__ $$aPujol, F.O.
000106580 700__ $$aOrozco, M.O.
000106580 700__ $$aOrtiz de Zarate, L.
000106580 700__ $$aGimenez, R.P.
000106580 700__ $$aGarcía, N.P.
000106580 700__ $$aCarazo, P.P.
000106580 700__ $$aCalvo, A.P.
000106580 700__ $$aCotore, J.P.
000106580 700__ $$aIdoate, C.P.
000106580 700__ $$aRoman, M.P.
000106580 700__ $$aBenítez, F.P.
000106580 700__ $$aPérez García, J.A.
000106580 700__ $$aPascual, M.P.
000106580 700__ $$aNieto, I.P.
000106580 700__ $$aMorgades, R.R.
000106580 700__ $$aPérez, M.R.
000106580 700__ $$aDuarte, Á.R.
000106580 700__ $$aSerrat, D.R.
000106580 700__ $$aRodamilans, X.
000106580 700__ $$aRuiz Carmona, M.D.
000106580 700__ $$aMartin, M.R.
000106580 700__ $$aAceituno, F.R.
000106580 700__ $$aMartínez, J.S.
000106580 700__ $$aSánchez de la Villa, G.
000106580 700__ $$aJimenez, I.S.
000106580 700__ $$aSierra Grañon, J.E.
000106580 700__ $$aBueno, A.S.
000106580 700__ $$aGil, A.S.
000106580 700__ $$aSanchez, T.T.
000106580 700__ $$aQuintana, N.U.
000106580 700__ $$aHernández, J.V.
000106580 700__ $$aVallribera, F.
000106580 700__ $$aPascual, V.V.
000106580 7102_ $$11011$$2615$$aUniversidad de Zaragoza$$bDpto. Microb.Ped.Radio.Sal.Pú.$$cÁrea Medic.Prevent.Salud Públ.
000106580 773__ $$g47, 2 (2021), P276-284$$pEur. j. surg. oncol.$$tEuropean Journal of Surgical Oncology$$x0748-7983
000106580 8564_ $$s216362$$uhttps://zaguan.unizar.es/record/106580/files/texto_completo.pdf$$yPostprint
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000106580 951__ $$a2023-05-18-13:20:11
000106580 980__ $$aARTICLE

Universidad de Zaragoza Repository