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

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 Re...

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Published in:	European journal of surgical oncology Vol. 47; no. 2; pp. 276 - 284
Main Authors:	Pellino, Gianluca, Alós, Rafael, Codina-Cazador, Antonio, Enríquez-Navascues, José María, Espín-Basany, Eloy, Roig-Vila, José Vicente, García-Granero, Eduardo, Carceller, Raúl Adell, Ais Conde, Juan Guillermo, Alonso, Evelio Alonso, Cortijo, Antonio Amaya, Sebastian, Antonio Arroyo, Baños, Pedro Barra, Solé, Ricard Batlle, Bernal Sprekelsen, Juan C., Biondo, Sebastiano, Blanco, Santiago, Bollo, J., Alvarado, Nieves Cáceres, Ausas, Ignasi Camps, Cid, Ramon Cantero, Carmona Saez, José Antonio, Nuñez, Enrique Casal, Capitán Morales, Luis Cristobal, Villarreal, Guillermo Carreño, Tebar, Jesús Cifuentes, Ciga Lozano, Miguel Á., Cazador, Antonio Codina, de Dios Franco Osorio, Juan, Olías, María de la Vega, de Miguel Velasco, Mario, Rodrigo del Valle, Sergio, Díaz Mejías, José G., Díaz Pavón, José M., Trill, Javier Die, Dominguez Tristancho, José L., Lindenbaum, Paula Dujovne, Alustiza, José Errasti, Macias, Alejandro Espí, Basany, Eloy Espín, Estévan, Rafael Estévan, Estevez Diz, Alfredo M., Flores, Luis, Fraccalvieri, Domenico, Garcea, Alessandro, Alonso, Mauricio García, Botella, Miguel Garcia, García Coret, Maria José, García García, José M., García, Jacinto García, Garijo Alvarez, Jesús Á., Gris, Fernando, Casanovas, Pilar Hernandez, Alvarez, Daniel Huerga, Jimenez Miramón, Francisco Javier, Vallejo, Alberto Lamiquiz, Casajuana, Félix Lluis, Lara, Manuel López, Lujan Mompean, Juan A., Maestre, María Victoria, Martínez, Eva Martí, Martinez, M., Gallego, Gabriel Martínez, Pardavila, Roberto Martinez, Díaz, Olga Maseda, Schedling, Mónica Millan, Mirón, Benito, Abad, José Monzón, Múgica Martinera, José A., Pujol, Francisco Olivet, Orozco, Mónica Orelogio, Ortiz de Zarate, Luis, Gimenez, Rosana Palasí, García, Natividad Palencia, Carazo, Pablo Palma, Calvo, Alberto Parajo, Cotore, Jesús Paredes, Idoate, Carlos Pastor, Roman, Miguel Pera, Benítez, Francisco Pérez, Pérez García, José A., Pascual, Marta Piñol, Nieto, Isabel Prieto, Morgades, Ricardo Rada, Pérez, Mónica Reig, Duarte, Ángel Reina, Serrat, Didac Ribé, Rodamilans, Xavier, Martin, Marcos Rodriguez, Aceituno, Francisco Romero, Martínez, Jesús Salas, Sánchez de la Villa, Ginés, Sierra Grañon, José Enrique, Gil, Albert Sueiras, Sanchez, Teresa Torres, Quintana, Natalia Uribe, Hernández, Javier Valdés, Vallribera, Fancesc, Pascual, Vicent Viciano
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-02-2021
Subjects:	Adult Aged Aged, 80 and over Chemoradiotherapy, Adjuvant Chemotherapy Female Follow-Up Studies Forecasting Humans Male Margins of Excision Middle Aged Neoadjuvant Therapy Neoadjuvant treatment Neoplasm Staging Prognosis Radiotherapy Rectal cancer Rectal Neoplasms - diagnosis Rectal Neoplasms - epidemiology Rectal Neoplasms - therapy Registries Retrospective Studies Spain - epidemiology Survival Survival Rate - trends T stage TNM Treatment Outcome Young Adult Spain TNM Chemotherapy T stage Prognosis Rectal cancer Radiotherapy Survival Neoadjuvant treatment
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Summary:	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. 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. 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. 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Undefined-2
ISSN:	0748-7983 1532-2157
DOI:	10.1016/j.ejso.2020.04.056