TY - JOUR
T1 - Time to surgery and pathologic complete response after neoadjuvant chemoradiation in rectal cancer: A population study on 2094 patients
AU - Macchia, Gabriella
AU - Gambacorta, Maria Antonietta
AU - Masciocchi, Carlotta
AU - Chiloiro, Giuditta
AU - Mantello, Giovanna
AU - Benedetto, Maika di
AU - Lupattelli, Marco
AU - Palazzari, Elisa
AU - Belgioia, Liliana
AU - Bacigalupo, Almalina
AU - Sainato, Aldo
AU - Montrone, Sabrina
AU - Turri, Lucia
AU - Caroli, Angela
AU - Paoli, Antonino De
AU - Matrone, Fabio
AU - Capirci, Carlo
AU - Montesi, Giampaolo
AU - Niespolo, Rita Marina
AU - Osti, Mattia Falchetto
AU - Caravatta, Luciana
AU - Galardi, Alessandra
AU - Genovesi, Domenico
AU - Rosetto, Maria Elena
AU - Boso, Caterina
AU - Sciacero, Piera
AU - Giaccherini, Lucia
AU - Parisi, Salvatore
AU - Fontana, Antonella
AU - Filippone, Francesco Romeo
AU - Picardi, Vincenzo
AU - Morganti1, Alessio Giuseppe
AU - Valentini, Vincenzo
PY - 2017
Y1 - 2017
N2 - Background: To retrospectively evaluate the difference in terms of pathologic complete response (pCR) according to time elapsed between chemoradiation (CRT) and total mesorectal excision (TME) on a large unselected real-life dataset of locally advanced rectal cancer (LARC) patients.
Methods: A multicentre retrospective cohort study of LARC patients from 21 Italian Radiotherapy Institutions was performed. Patients were stratified into 3 different time intervals from CRT. The 1st group included 300 patients who underwent TME within 6 weeks, the 2nd 1598 patients (TME within 7-12 weeks) and the 3rd 196 patients (TME within 13 or more weeks after CRT), respectively.
Results: Data on 2094 LARC patients treated between 1997 and 2016 were considered suitable for analysis. Overall, 578 patients had stage II while 1516 had stage III histological proven invasive rectal adenocarcinoma. A CRT schedule of one agent (N = 1585) or 2-drugs (N = 509) was administered. Overall, pCR was 22.3% (N = 468 patients). The proportion of patients achieving pCR with respect to time interval was, as follows: 12.6% (1st group), 23% (2nd group) and 31.1% (3rd group) (p < 0.001), respectively. The pCR relative risk comparison of 2nd to 1st group was 1.8, while 3rd to 2nd group was 1.3. Moreover, between the 3rd and 1st group, a pCR relative risk of 2.4 (p < 0.01) was noted. At univariate analysis, clinical stage III (p < 0.001), radiotherapy dose >5040 cGy (p = 0.002) and longer interval (p < 0.001) were significantly correlated to pCR. The positive impact of interval (p < 0.001) was confirmed at multivariate analysis as the only correlated factor.
Conclusion: We confirmed on a population-level that lengthening the interval (>13 weeks) from CRT to surgery improves the pathological response (pCR and pathologic partial response; pPR) in comparison to historic data. Furthermore, radiotherapy dose >5040 cGy and two drugs chemotherapy correlated with pPR rate.
AB - Background: To retrospectively evaluate the difference in terms of pathologic complete response (pCR) according to time elapsed between chemoradiation (CRT) and total mesorectal excision (TME) on a large unselected real-life dataset of locally advanced rectal cancer (LARC) patients.
Methods: A multicentre retrospective cohort study of LARC patients from 21 Italian Radiotherapy Institutions was performed. Patients were stratified into 3 different time intervals from CRT. The 1st group included 300 patients who underwent TME within 6 weeks, the 2nd 1598 patients (TME within 7-12 weeks) and the 3rd 196 patients (TME within 13 or more weeks after CRT), respectively.
Results: Data on 2094 LARC patients treated between 1997 and 2016 were considered suitable for analysis. Overall, 578 patients had stage II while 1516 had stage III histological proven invasive rectal adenocarcinoma. A CRT schedule of one agent (N = 1585) or 2-drugs (N = 509) was administered. Overall, pCR was 22.3% (N = 468 patients). The proportion of patients achieving pCR with respect to time interval was, as follows: 12.6% (1st group), 23% (2nd group) and 31.1% (3rd group) (p < 0.001), respectively. The pCR relative risk comparison of 2nd to 1st group was 1.8, while 3rd to 2nd group was 1.3. Moreover, between the 3rd and 1st group, a pCR relative risk of 2.4 (p < 0.01) was noted. At univariate analysis, clinical stage III (p < 0.001), radiotherapy dose >5040 cGy (p = 0.002) and longer interval (p < 0.001) were significantly correlated to pCR. The positive impact of interval (p < 0.001) was confirmed at multivariate analysis as the only correlated factor.
Conclusion: We confirmed on a population-level that lengthening the interval (>13 weeks) from CRT to surgery improves the pathological response (pCR and pathologic partial response; pPR) in comparison to historic data. Furthermore, radiotherapy dose >5040 cGy and two drugs chemotherapy correlated with pPR rate.
KW - rectal cancer
KW - rectal cancer
UR - http://hdl.handle.net/10807/235412
U2 - 10.1016/j.ctro.2017.04.004
DO - 10.1016/j.ctro.2017.04.004
M3 - Article
SN - 2405-6308
SP - N/A-N/A
JO - Clinical and Translational Radiation Oncology
JF - Clinical and Translational Radiation Oncology
ER -
