Perioperative safety evaluation of three different neoadjuvant (chemo) radiotherapy regimens in mid-low rectal cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HU Tao , ZHENG Erliang , GU Chaoyang ,  DENG Xiangbing , WANG Ziqiang

Department of Gastrointestinal and Colorectal Surgery, West China Hospital, Chengdu 610041, P. R. China;

Corresponding author：

DENG Xiangbing, Email: 247940362@qq.com

Keywords：

mid-low rectal cancer; short course radiation; neoadjuvant long-course chemoradiotherapy; total neoadjuvant treatment; complication; safety

DOI：

10.7507/1007-9424.201710063

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the effects of neoadjuvant long-course chemoradiotherapy (CRT), neoadjuvant short-course radiotherapy (SCRT), and total neoadjuvant treatment (TNT) on chemoradiotherapy related complications and perioperative safety in mid-low rectal cancer patients. Methods The clinical data of 63 rectal cancer patients who received neoadjuvant (chemo) radiotherapies and surgery treatment in West China Hospital from Jul. 2014 to Feb. 2016 were retrospectively analyzed. According to the neoadjuvant regimen, the patients were divided into CRT group (n=15), SCRT group (n=30), and TNT group (n=18), and then the effects of these 3 kinds of neoadjuvant regimen on chemoradiotherapy related complications and perioperative safety were compared. Results ① Chemoradiotherapy related complications: among all the included 63 patients, 29 patients (46.0%) occurred chemoradiotherapy related complications, including radiation enteritis in 9 patients and bone marrow suppression in 25 patients. There were significant differences in the overall incidence of chemoradiotherapy related complications, incidence of radiation enteritis and bone marrow suppression (P≤0.001). The overall incidence of chemoradiotherapy related complications and incidence of bone marrow suppression of SCRT group were lower. ② Perioperative safety: no significant differences were found in the incidence of surgical complications, incidence of specific surgical complication, operation duration, intraoperative blood loss, and postoperative flatus time (P<0.05), but there was significant difference in the postoperative hospital stay among 3 groups (P=0.033), the postoperative hospital stay of SCRT group was shorter. Conclusion CRT, SCRT, and TNT have similar effect on the safety in the mid-low rectal cancer patients, which suggests that SCRT is worthy of further research and promotion.

Citation： HU Tao, ZHENG Erliang, GU Chaoyang, DENG Xiangbing, WANG Ziqiang. Perioperative safety evaluation of three different neoadjuvant (chemo) radiotherapy regimens in mid-low rectal cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(11): 1321-1325. doi: 10.7507/1007-9424.201710063 Copy

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4.	Swedish Rectal Cancer Trial, Cedermark B, Dahlberg M, et al. Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med, 1997, 336(14): 980-987.
5.	van Gijn W, Marijnen CA, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol, 2011, 12(6): 575-582.
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11.	Franke AJ, Parekh H, Starr JS, et al. Total neoadjuvant therapy: a shifting paradigm in locally advanced rectal cancer management. Clin Colorectal Cancer, 2017, [Epub ahead of print].
12.	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(10): 1215-1223.
13.	Watanabe T, Itabashi M, Shimada Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. Int J Clin Oncol, 2012, 17(1): 1-29.
14.	Watanabe T, Itabashi M, Shimada Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) Guidelines 2014 for treatment of colorectal cancer. Int J Clin Oncol, 2015, 20(2): 207-239.
15.	Watanabe T, Muro K, Ajioka Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer. Int J Clin Oncol, 2017, [Epub ahead of print].
16.	Pettersson D, Cedermark B, Holm T, et al. Interim analysis of the StockholmⅢ trial of preoperative radiotherapy regimens for rectal cancer. Br J Surg, 2010, 97(4): 580-587.
17.	Pettersson D, Glimelius B, Iversen H, et al. Impaired postoperative leucocyte counts after preoperative radiotherapy for rectal cancer in the Stockholm Ⅲ Trial. Br J Surg, 2013, 100(7): 969-975.
18.	Deng Y, Chi P, Lan P, et al. Modified FOLFOX6 with or without radiation versus fluorouracil and leucovorin with radiation in neoadjuvant treatment of locally advanced rectal cancer: initial results of the Chinese FOWARC multicenter, open-label, randomized three-arm phaseⅢ Trial. J Clin Oncol, 2016, 34(27): 3300-3307.
19.	Pettersson D, Holm T, Iversen H, et al. Preoperative short-course radiotherapy with delayed surgery in primary rectal cancer. Br J Surg, 2012, 99(4): 577-583.
20.	Wang ZQ, Deng XB, Liu P, et al. Neoadjuvant radiotherapy vs. surgery alone for stage Ⅱ/Ⅲ mid-low rectal cancer with or without high risk factors: a multicenter randomized trial. J Clin Oncol, 2017, 35: 3537.
21.	Slagsvold JE, Viset T, Wibe A, et al. Radiation therapy did not induce long-term changes in rectal mucosa: results from the randomized scandinavian prostate cancer group 7 trial. Int J Radiat Oncol Biol Phys, 2016, 95(4): 1268-1272.

1. Glimelius B, Pahlman L, Cervantes A, et al. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2010, 21 Suppl 5: v82-v86.
2. NCCN. Clinical practice guidelines in oncology. Rectal cancer, Version 2. 2017. https://www.nccn.org/.
3. Sebag-Montefiore D, Stephens RJ, Steele R, et al. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet, 2009, 373(9666): 811-820.
4. Swedish Rectal Cancer Trial, Cedermark B, Dahlberg M, et al. Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med, 1997, 336(14): 980-987.
5. van Gijn W, Marijnen CA, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol, 2011, 12(6): 575-582.
6. Ansari N, Solomon MJ, Fisher RJ, et al. Acute adverse events and postoperative complications in a randomized trial of preoperative short-course radiotherapy versus long-course chemoradiotherapy for T3 adenocarcinoma of the rectum: trans-tasman radiation oncology group trial (TROG 01.04). Ann Surg, 2017, 265(5): 882-888.
7. 申丽君, 章真. 局部进展期直肠癌的放疗规范及其进展. 中华胃肠外科杂志, 2016, 19(6): 618-620.
8. 陈琼, 宋国慧, 孙喜斌, 等. 2003～2007 年中国结直肠癌发病与死亡分析. 中国肿瘤, 2012, 21(3): 179-182.
9. 丘嘉煌, 李燕, 李科, 等. 广州市 2004-2013 年结直肠癌发病趋势分析. 广东医学, 2016, 37(22): 3334-3337.
10. Ngan SY, Burmeister B, Fisher RJ, et al. Randomized trial of short-course radiotherapy versus long-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(31): 3827-3833.
11. Franke AJ, Parekh H, Starr JS, et al. Total neoadjuvant therapy: a shifting paradigm in locally advanced rectal cancer management. Clin Colorectal Cancer, 2017, [Epub ahead of print].
12. 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(10): 1215-1223.
13. Watanabe T, Itabashi M, Shimada Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. Int J Clin Oncol, 2012, 17(1): 1-29.
14. Watanabe T, Itabashi M, Shimada Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) Guidelines 2014 for treatment of colorectal cancer. Int J Clin Oncol, 2015, 20(2): 207-239.
15. Watanabe T, Muro K, Ajioka Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer. Int J Clin Oncol, 2017, [Epub ahead of print].
16. Pettersson D, Cedermark B, Holm T, et al. Interim analysis of the StockholmⅢ trial of preoperative radiotherapy regimens for rectal cancer. Br J Surg, 2010, 97(4): 580-587.
17. Pettersson D, Glimelius B, Iversen H, et al. Impaired postoperative leucocyte counts after preoperative radiotherapy for rectal cancer in the Stockholm Ⅲ Trial. Br J Surg, 2013, 100(7): 969-975.
18. Deng Y, Chi P, Lan P, et al. Modified FOLFOX6 with or without radiation versus fluorouracil and leucovorin with radiation in neoadjuvant treatment of locally advanced rectal cancer: initial results of the Chinese FOWARC multicenter, open-label, randomized three-arm phaseⅢ Trial. J Clin Oncol, 2016, 34(27): 3300-3307.
19. Pettersson D, Holm T, Iversen H, et al. Preoperative short-course radiotherapy with delayed surgery in primary rectal cancer. Br J Surg, 2012, 99(4): 577-583.
20. Wang ZQ, Deng XB, Liu P, et al. Neoadjuvant radiotherapy vs. surgery alone for stage Ⅱ/Ⅲ mid-low rectal cancer with or without high risk factors: a multicenter randomized trial. J Clin Oncol, 2017, 35: 3537.
21. Slagsvold JE, Viset T, Wibe A, et al. Radiation therapy did not induce long-term changes in rectal mucosa: results from the randomized scandinavian prostate cancer group 7 trial. Int J Radiat Oncol Biol Phys, 2016, 95(4): 1268-1272.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Perioperative safety evaluation of three different neoadjuvant (chemo) radiotherapy regimens in mid-low rectal cancer

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