Short-course radiation with consolidation chemotherapy does not increase operative morbidity compared to long-course chemoradiation : A retrospective study of the US rectal cancer consortium
© 2023 Wiley Periodicals LLC..
BACKGROUND AND OBJECTIVES: Neoadjuvant short-course radiation and consolidation chemotherapy (SC TNT) remains less widely used for rectal cancer in the United States than long-course chemoradiation (LCRT). SC TNT may improve compliance and downstaging; however, a longer radiation-to-surgery interval may worsen pelvic fibrosis and morbidity with total mesorectal excision (TME). A single, US-center retrospective analysis has shown comparable risk of morbidity after neoadjuvant short-course radiation with consolidation chemotherapy (SC TNT) and long-course chemoradiation (LCRT). Validation by a multi-institutional study is needed.
METHODS: The US Rectal Cancer Consortium database (2010-2018) was retrospectively reviewed for patients with nonmetastatic, rectal adenocarcinoma treated with neoadjuvant LCRT or SC TNT before TME. The primary endpoint was severe postoperative morbidity. Cohorts were compared by univariate analysis. Multivariable logistic regression modeled the odds of severe complication.
RESULTS: Of 788 included patients, 151 (19%) received SC TNT and 637 (81%) LCRT. The SC TNT group had fewer distal tumors (33.8% vs. 50.2%, p < 0.0001) and more clinical node-positive disease (74.2% vs. 47.6%, p < 0.0001). The intraoperative complication rate was similar (SC TNT 5.3% vs. 4.4%, p = 0.65). There was no difference in overall postoperative morbidity (38.4% vs. 46.3%, p = 0.08). Severe morbidity was similar with low anterior resection (9.1% vs. 15.3%, p = 0.10) and abdominoperineal resection (24.4% vs. 29.7%, p = 0.49). SC TNT did not increase the odds of severe morbidity relative to LCRT on multivariable analysis (OR 0.64, 95% CI 0.37-1.10).
CONCLUSIONS: SC TNT does not increase morbidity after TME for rectal cancer relative to LCRT. Concern for surgical complications should not discourage the use of SC TNT when aiming to increase the likelihood of complete clinical response.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2024 |
|---|---|
| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:129 |
|---|---|
| Enthalten in: |
Journal of surgical oncology - 129(2024), 2 vom: 17. Feb., Seite 254-263 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Bauer, Philip S [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Journal Article |
|---|
| Anmerkungen: |
Date Completed 10.01.2024 Date Revised 18.02.2024 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1002/jso.27468 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM362863865 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM362863865 | ||
| 003 | DE-627 | ||
| 005 | 20240218231857.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2024 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1002/jso.27468 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1298.xml |
| 035 | |a (DE-627)NLM362863865 | ||
| 035 | |a (NLM)37792637 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Bauer, Philip S |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Short-course radiation with consolidation chemotherapy does not increase operative morbidity compared to long-course chemoradiation |b A retrospective study of the US rectal cancer consortium |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 10.01.2024 | ||
| 500 | |a Date Revised 18.02.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2023 Wiley Periodicals LLC. | ||
| 520 | |a BACKGROUND AND OBJECTIVES: Neoadjuvant short-course radiation and consolidation chemotherapy (SC TNT) remains less widely used for rectal cancer in the United States than long-course chemoradiation (LCRT). SC TNT may improve compliance and downstaging; however, a longer radiation-to-surgery interval may worsen pelvic fibrosis and morbidity with total mesorectal excision (TME). A single, US-center retrospective analysis has shown comparable risk of morbidity after neoadjuvant short-course radiation with consolidation chemotherapy (SC TNT) and long-course chemoradiation (LCRT). Validation by a multi-institutional study is needed | ||
| 520 | |a METHODS: The US Rectal Cancer Consortium database (2010-2018) was retrospectively reviewed for patients with nonmetastatic, rectal adenocarcinoma treated with neoadjuvant LCRT or SC TNT before TME. The primary endpoint was severe postoperative morbidity. Cohorts were compared by univariate analysis. Multivariable logistic regression modeled the odds of severe complication | ||
| 520 | |a RESULTS: Of 788 included patients, 151 (19%) received SC TNT and 637 (81%) LCRT. The SC TNT group had fewer distal tumors (33.8% vs. 50.2%, p < 0.0001) and more clinical node-positive disease (74.2% vs. 47.6%, p < 0.0001). The intraoperative complication rate was similar (SC TNT 5.3% vs. 4.4%, p = 0.65). There was no difference in overall postoperative morbidity (38.4% vs. 46.3%, p = 0.08). Severe morbidity was similar with low anterior resection (9.1% vs. 15.3%, p = 0.10) and abdominoperineal resection (24.4% vs. 29.7%, p = 0.49). SC TNT did not increase the odds of severe morbidity relative to LCRT on multivariable analysis (OR 0.64, 95% CI 0.37-1.10) | ||
| 520 | |a CONCLUSIONS: SC TNT does not increase morbidity after TME for rectal cancer relative to LCRT. Concern for surgical complications should not discourage the use of SC TNT when aiming to increase the likelihood of complete clinical response | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a morbidity | |
| 650 | 4 | |a rectal cancer | |
| 650 | 4 | |a short-course radiation | |
| 650 | 4 | |a total neoadjuvant therapy | |
| 700 | 1 | |a Gamboa, Adriana C |e verfasserin |4 aut | |
| 700 | 1 | |a Otegbeye, Ebunoluwa E |e verfasserin |4 aut | |
| 700 | 1 | |a Chapman, William C |e verfasserin |4 aut | |
| 700 | 1 | |a Rivard, Samantha |e verfasserin |4 aut | |
| 700 | 1 | |a Regenbogen, Scott |e verfasserin |4 aut | |
| 700 | 1 | |a Mohammed, Maryam |e verfasserin |4 aut | |
| 700 | 1 | |a Holder-Murray, Jennifer |e verfasserin |4 aut | |
| 700 | 1 | |a Wiseman, Jason T |e verfasserin |4 aut | |
| 700 | 1 | |a Ejaz, Aslam |e verfasserin |4 aut | |
| 700 | 1 | |a Edwards-Hollingsworth, Kamren |e verfasserin |4 aut | |
| 700 | 1 | |a Hawkins, Alexander T |e verfasserin |4 aut | |
| 700 | 1 | |a Hunt, Steven R |e verfasserin |4 aut | |
| 700 | 1 | |a Balch, Glen |e verfasserin |4 aut | |
| 700 | 1 | |a Silviera, Matthew L |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Journal of surgical oncology |d 1969 |g 129(2024), 2 vom: 17. Feb., Seite 254-263 |w (DE-627)NLM000052930 |x 1096-9098 |7 nnns |
| 773 | 1 | 8 | |g volume:129 |g year:2024 |g number:2 |g day:17 |g month:02 |g pages:254-263 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1002/jso.27468 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 129 |j 2024 |e 2 |b 17 |c 02 |h 254-263 | ||