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

Resumen: Introduction: 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.

Idioma: Inglés

DOI: 10.1016/j.ejso.2020.04.056

Año: 2021

Publicado en: European Journal of Surgical Oncology 47, 2 (2021), P276-284
ISSN: 0748-7983

Factor impacto JCR: 4.037 (2021)

Categ. JCR: SURGERY rank: 41 / 214 = 0.192 (2021) - Q1 - T1
Categ. JCR: ONCOLOGY rank: 132 / 245 = 0.539 (2021) - Q3 - T2

Factor impacto CITESCORE: 6.2 - Medicine (Q1)

Factor impacto SCIMAGO: 1.016 - Surgery (Q1) - Medicine (miscellaneous) (Q1)

Tipo y forma: Artículo (PostPrint)

Área (Departamento): Área Medic.Prevent.Salud Públ. (Dpto. Microb.Ped.Radio.Sal.Pú.)