Clinical outcomes of neoadjuvant chemoradiotherapy followed by total mesorectal excision in locally advanced rectal cancer with mesorectal fascia involvement
- Author:
Jeong Ha LEE
1
;
Nalee KIM
;
Jeong Il YU
;
Gyu Sang YOO
;
Hee Chul PARK
;
Woo-Yong LEE
;
Seong Hyeon YUN
;
Hee Cheol KIM
;
Yong Beom CHO
;
Jung Wook HUH
;
Yoon Ah PARK
;
Jung Kyong SHIN
;
Joon Oh PARK
;
Seung Tae KIM
;
Young Suk PARK
;
Jeeyun LEE
;
Won Ki KANG
Author Information
- Publication Type:Original Article
- From:Radiation Oncology Journal 2024;42(2):130-138
- CountryRepublic of Korea
- Language:English
-
Abstract:
Purpose:For the treatment of locally advanced rectal cancer (LARC), research on primary lesions with mesorectal fascia (MRF) involvement is lacking. This study analyzed the clinical outcomes and efficacy of dose-escalated neoadjuvant concurrent chemoradiotherapy (NCRT) to patients with LARC involving MRF.
Materials and Methods:We retrospectively reviewed 301 patients who were diagnosed with LARC involving MRF and underwent NCRT followed by total mesorectal excision (TME). Patients who received radiotherapy (RT) doses of ≤50.4 Gy were defined as the non-boost group, while ≥54.0 Gy as the boost group. Pathological tumor response and survival outcomes, including intrapelvic recurrence-free survival (IPRFS), distant metastases-free survival (DMFS) and overall survival (OS), were analyzed.
Results:A total of 269 patients (89.4%) achieved a negative pathological circumferential resection margin and 104 (34.6%) had good pathological tumor regression grades. With a median follow-up of 32.4 months, IPRFS, DMFS, and OS rates at 5-years were 88.6%, 78.0%, and 91.2%, respectively. In the subgroup analysis by RT dose, the boost group included more advanced clinical stages of patients. For the non-boost group and boost group, 5-year IPRFS rates were 90.3% and 87.0% (p = 0.242), 5-year DMFS rates were 82.0% and 71.3% (p = 0.105), and 5-year OS rates were 93.0% and 80.6% (p = 0.439), respectively. Treatment related toxicity was comparable between the two groups (p = 0.211).
Conclusion:Although this retrospective study failed to confirm the efficacy of dose-escalated NCRT, favorable IPRFS and pathological complete response was achieved with NCRT followed by TME. Further studies combining patient customized RT dose with systemic therapies are needed.
