Current status in the treatment of rectal cancer in the Czech Republic regarding the rate of complete pathological response after neoadjuvant therapy – PATOD C20 study 2011−2012
Authors:
T. Dušek 1,2; A. Ferko 1; M. Bláha 3; L. Dušek 3; D. Malúšková 3; J. Örhalmi 1; J. Dolejš 4; M. Vošmik 5
Authors‘ workplace:
Chirurgická klinika FN Hradec Králové a Lékařské fakulty UK v Hradci Králové
přednosta kliniky: prof. MUDr. A. Ferko, CSc.
1; Katedra vojenské chirurgie, Fakulta vojenského zdravotnictví, Hradec Králové, Univerzita obrany, Brno
vedoucí: doc. MUDr. J. Páral, Ph. D.
2; Institut biostatistiky a analýz Lékařské a Přírodovědecké fakulty Masarykovy univerzity, Brno
ředitel doc. RNDr. L. Dušek, Ph. D.
3; Katedra informatiky a kvantitativních metod, Fakulta informatiky a managementu, Univerzita v Hradci Králové
vedoucí katedry: doc. RNDr. P. Pražák, Ph. D.
4; Klinika onkologie a radiologie FN Hradec Králové a Lékařské fakulty UK v Hradci Králové
přednosta kliniky: prof. MUDr. J. Petera, Ph. D.
5
Published in:
Rozhl. Chir., 2015, roč. 94, č. 7, s. 276-282.
Category:
Original articles
Overview
Introduction:
Deciding on the strategy in rectal cancer´s treatment requires a complex and multidisciplinary approach. The primary rectal resection is indicated in early stages, while locally advanced tumors should be pretreated by one of the modes of neoadjuvant (chemo) radiotherapy. The main goal of this study was to explore the therapeutic strategy in patients with rectal cancer in the Czech Republic. The second aim was to determine the incidence of the pathological complete response after neoadjuvant therapy.
Methods:
This is a retrospective multicenter clinical study, which includes data from all patients with rectal cancer who were treated at participating centers in the period from 01/01/2011 to 31/12/2012. The required data has been passed into the online registry PATOD C20.Three issues have been set up: 1. Characteristics of the center and cooperation with the oncological department; 2. Characteristics of the treatment of patients with rectal cancer; and 3. Detailed analysis of the group of patients with complete pathological response. The analysis was performed with regard to the nature of individual departments, i.e. departments of surgery in university hospitals with complex oncological centres, departments of surgery within complex oncologic centers, and departments of surgery outside complex oncologic centers
Results:
In total, 21 departments of surgery in the Czech Republic provided data about 1860 patients with rectal cancer for the study. The treatment strategy for rectal cancer was determined at multidisciplinary seminars at 19 centers (90.5%). Statistically significant differences between the centers were found in the indication for neoadjuvant treatment (p<0.001), rectal resection with anastomosis (p = 0.048), and resection without anastomosis (p = 0.022). Complete pathological response was found in 61 (8.7%) patients. Positivity of mesorectal lymph nodes (ypN+) was found in the case of ypT0 stage in 7 (9.7%) patients.
Conclusion:
PATOD study showed that therapy of rectal cancer is highly heterogeneous in the Czech Republic. Despite the best conditions provided, university hospitals and large departments within complex oncologic centers do not fully utilize this benefit.
Key words:
rectal cancer – neoadjuvant therapy – chemoradiotherapy – complete pathological response
Sources
1. Nussbaum N, Altomare I. The neoadjuvant treatment of the rectal cancer: a review. Curr Oncol Rep 2015;17:434.
2. Valentini V, Aristei C, Glimelius B, et al. Multidisciplinary rectal cancer management: 2nd European Rectal Cancer Consensus Conference (EURECA-CC2). Radiother Oncol 2009;92:148−63.
3. van Leersum NJ, Janssen-Heijnen MLG, et al. Incresing of comorbidity in patients with colorectal cancer in the South Netherlands 1995-2010. Int J Cancer 2013;132:2157−63.
4. Hoch J. Chirurgická léčba kolorektálního karcinomu. Rozhl Chir 2012; 91: 48−52.
5. Dušek T, Ferko A, Örhalmi J, et al. Karcinom rekta do 10 cm (Srovnání radikality laparoskopické a otevřené operační techniky s ohledem na cirkumferentní resekční okraj a na kompletnost mezorektální excize.) Rozhl Chir 2013; 92:20−6.
6. Monson JRT, Weiser MR, Buie WD, et al. Practice parameters for the management of rectal cancer (revised). Dis Col Rectum 2013;56:535−50.
7. Ngan SY, Burmeister B, Fischer RJ, et al. Randomized trial of short course radiotherapy versus longe course chemoradiation comparing rates of local recurrence in patients with T3 rectal cancer. Trans Tasman Radiation Oncology Group Trial 01.04. J Clin Oncol 2012;30:3827−33.
8. Bujko K, Nowacki MP, Nasierowska-Guttmejer A, et al. Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg 2006;93:1215−23.
9. Sauer R, Liersch T, Merkel S. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol 2012;30: 1926−33.
10. Fucini C, Pucciani F, Elbetti C, et al. Preoperative radiochemotherapy in T3 operable low rectal cancers: A gold standard? World J Surg 2010;34:1609−14.
11. Lombardi R, Cuicchi D, Pinto C, et al. Clinically-staged T3N0 rectal cancer: Is preoperative chemoradiotherapy the optimal treatment? Ann Surg Oncol 2010;17:838−45.
12. Elliot AH, Martling A, Glimelius B, et al. Preoperative treatment selection in rectal cancer: A population-based cohort study. Eur J Surg Oncol 2014 40:1782−8.
13. Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004;351:1731−40.
14. Dworak O, Keilholz L, Hoffmann A, et al. Pathological features of rectal cancer after preoperative radiochemotherapy. Int J Colorect Dis 2007;12:19−23.
15. Stipa F, Picchio M, Burza A, et al. Long-term outcome of local excision after preoperative chemoradiation for ypT0 rectal cancer. Dis Col Rectum 2014;57:1245−52.
16. Sinukumar S, Patil P, Enginner R, et al. Clinical outcome of patients with complete pathological response to neoadjuvant chemoradiotherapy for locally advanced rectal cancers: the Indian scenario. Gastroenterol Res Pract 2014; Published online doi: 10.1155/2014/867841.
17. Sclafani F, Cunningham D, et al. Neoadjuvant chemotherapy without radiotherapy for locally advanced rectal cancer. Future Oncol 2014;10.2243−57.
18. Kapiteijn E, Marijnen CAM, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001;345:638−46.
19. Garcia-Aguilar J, Smith DD, Avila K, et al. Optimal timing of surgery after chemoradiation for advanced rectal cancer. Preliminary results of multi-center, non-randomized phase II prospective trial. Ann Surg 2011;254:97−102.
20. Maas M, Nelemans PJ, Valentini V, et al. Long-term outcome in patients with a pathologial complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data. Lancet Oncol 2010;11:835−44.
21. Rödel C, Martus P, Papadoupolos T, et al. Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol 2005;23: 8688−96.
22. Berardi R, Maccaroni E, Onofri A, et al. Locally advanced rectal cancer: the importance of a multidisciplinary approach. World J Gastroenterol 2014;20:17279−87.
23. García-Flórez LJ, Gómez-Álvarez G, Grunza AM, et al. Predictive markers of response to neoadjuvant therapy in rectal cancer. J Surg Res 2015;194:120−6.
24. Yeo SG, Kim DY, Kim TH, et al. Pathologic complete response of primary tumour following preoperative chemoradiotherapy for locally advanced rectal cancer: Long-term outcomes and prognostic significance of pathologic nodal status (KROG 09-01). Ann Surg 2010;252:998−1004.
25. Hughes R, Glynne-Jones R, Grainger J, et al. Can pathological complete response in the primary tomour following preoperative pelvic chemoradiotherapy for T3-T4 rectal cancer predict for sterilisation of pelvic lymph nodes, a low risk of local reccurence and appropriateness of local excision? Int J Colorectal Dis 2006;21:11−7.
26. Glynne-Jones R, Wallace M, Livingstone JIL, et al. Complete clinical response after chemoradiation in rectal cancer: is a “wait and see“ policy justified? Dis Col Rectum 2008;51:10−9.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2015 Issue 7
Most read in this issue
- Pruritus ani
- SentiMag – the magnetic detection system of sentinel lymph nodes in breast cancer
- Heterotopic mesenteric ossification
- Acute bleeding into the GI tract – A surgical diagnosis?