Neoadjuvant chemo-radiotherapy for cT3N0 rectal cancer: any benefit over upfront surgery? A propensity score-matched study

Luca Sorrentino, Marcello Guaglio, Luigi Battaglia, Giuliano Bonfanti, Marco Vitellaro, Alessandro Cesa Bianchi, Massimo Milione, Filiberto Belli

Research output: Contribution to journalArticle

Abstract

Purpose: Benefits of neoadjuvant chemo-radiotherapy (CRT) are well known for locally advanced and/or node-positive rectal cancer, but the best timing for CRT has been less explored for cT3N0 patients. The aim of the present study was to compare the 5-year disease-free survival (DFS) probability between neoadjuvant CRT and upfront surgery in patients affected by cT3N0 rectal cancer. Methods: A retrospective review of 105 patients affected by cT3N0 rectal cancer, staged by pelvic magnetic resonance imaging and treated at the National Cancer Institute of Milan between 2011 and 2017, was performed: 42 (40.0%) were treated by neoadjuvant CRT and 63 (60.0%) by upfront surgery. Propensity score matching was performed to avoid selection bias, and Cox multivariate regression was used to analyze outcomes. Results: The 5-year DFS probability was 87.5% in neoadjuvant CRT patients vs. 90.0% in upfront surgery cases (Log-rank p = 0.76). The 5-year loco-regional recurrence-free survival probability was respectively 96.8% vs. 96.3% (Log-rank p = 0.954). On multivariate analysis, neoadjuvant CRT had no impact on DFS when compared to upfront surgery (adjusted HR 0.71, 95%CI 0.18–2.70, p = 0.613), but 61.9% of upfront surgery cases were treated by adjuvant chemo-radiation (adjusted HR 0.41, 95%CI 0.11–1.57, p = 0.196). The only independent predictor of improved DFS was age at diagnosis (adjusted HR 0.95, p = 0.017). Conclusion: CRT should be considered for cT3N0 patients, but its timing (neoadjuvant vs. adjuvant) seems not to affect the disease-free survival in the present cohort of patients.

Original languageEnglish
Pages (from-to)2161-2169
Number of pages9
JournalInternational Journal of Colorectal Disease
Volume34
Issue number12
DOIs
Publication statusPublished - Dec 1 2019

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Propensity Score
Rectal Neoplasms
Radiotherapy
Disease-Free Survival
National Cancer Institute (U.S.)
Selection Bias
Multivariate Analysis
Magnetic Resonance Imaging
Radiation
Recurrence
Survival

Keywords

  • Adjuvant radiotherapy
  • Neoadjuvant chemo-radiation therapy
  • Rectal cancer
  • Surgery
  • T3N0

ASJC Scopus subject areas

  • Gastroenterology

Cite this

@article{bd7e728574be4c53aa065e5eeb2d69b2,
title = "Neoadjuvant chemo-radiotherapy for cT3N0 rectal cancer: any benefit over upfront surgery? A propensity score-matched study",
abstract = "Purpose: Benefits of neoadjuvant chemo-radiotherapy (CRT) are well known for locally advanced and/or node-positive rectal cancer, but the best timing for CRT has been less explored for cT3N0 patients. The aim of the present study was to compare the 5-year disease-free survival (DFS) probability between neoadjuvant CRT and upfront surgery in patients affected by cT3N0 rectal cancer. Methods: A retrospective review of 105 patients affected by cT3N0 rectal cancer, staged by pelvic magnetic resonance imaging and treated at the National Cancer Institute of Milan between 2011 and 2017, was performed: 42 (40.0{\%}) were treated by neoadjuvant CRT and 63 (60.0{\%}) by upfront surgery. Propensity score matching was performed to avoid selection bias, and Cox multivariate regression was used to analyze outcomes. Results: The 5-year DFS probability was 87.5{\%} in neoadjuvant CRT patients vs. 90.0{\%} in upfront surgery cases (Log-rank p = 0.76). The 5-year loco-regional recurrence-free survival probability was respectively 96.8{\%} vs. 96.3{\%} (Log-rank p = 0.954). On multivariate analysis, neoadjuvant CRT had no impact on DFS when compared to upfront surgery (adjusted HR 0.71, 95{\%}CI 0.18–2.70, p = 0.613), but 61.9{\%} of upfront surgery cases were treated by adjuvant chemo-radiation (adjusted HR 0.41, 95{\%}CI 0.11–1.57, p = 0.196). The only independent predictor of improved DFS was age at diagnosis (adjusted HR 0.95, p = 0.017). Conclusion: CRT should be considered for cT3N0 patients, but its timing (neoadjuvant vs. adjuvant) seems not to affect the disease-free survival in the present cohort of patients.",
keywords = "Adjuvant radiotherapy, Neoadjuvant chemo-radiation therapy, Rectal cancer, Surgery, T3N0",
author = "Luca Sorrentino and Marcello Guaglio and Luigi Battaglia and Giuliano Bonfanti and Marco Vitellaro and Bianchi, {Alessandro Cesa} and Massimo Milione and Filiberto Belli",
year = "2019",
month = "12",
day = "1",
doi = "10.1007/s00384-019-03446-4",
language = "English",
volume = "34",
pages = "2161--2169",
journal = "International Journal of Colorectal Disease",
issn = "0179-1958",
publisher = "Springer Verlag",
number = "12",

}

TY - JOUR

T1 - Neoadjuvant chemo-radiotherapy for cT3N0 rectal cancer

T2 - any benefit over upfront surgery? A propensity score-matched study

AU - Sorrentino, Luca

AU - Guaglio, Marcello

AU - Battaglia, Luigi

AU - Bonfanti, Giuliano

AU - Vitellaro, Marco

AU - Bianchi, Alessandro Cesa

AU - Milione, Massimo

AU - Belli, Filiberto

PY - 2019/12/1

Y1 - 2019/12/1

N2 - Purpose: Benefits of neoadjuvant chemo-radiotherapy (CRT) are well known for locally advanced and/or node-positive rectal cancer, but the best timing for CRT has been less explored for cT3N0 patients. The aim of the present study was to compare the 5-year disease-free survival (DFS) probability between neoadjuvant CRT and upfront surgery in patients affected by cT3N0 rectal cancer. Methods: A retrospective review of 105 patients affected by cT3N0 rectal cancer, staged by pelvic magnetic resonance imaging and treated at the National Cancer Institute of Milan between 2011 and 2017, was performed: 42 (40.0%) were treated by neoadjuvant CRT and 63 (60.0%) by upfront surgery. Propensity score matching was performed to avoid selection bias, and Cox multivariate regression was used to analyze outcomes. Results: The 5-year DFS probability was 87.5% in neoadjuvant CRT patients vs. 90.0% in upfront surgery cases (Log-rank p = 0.76). The 5-year loco-regional recurrence-free survival probability was respectively 96.8% vs. 96.3% (Log-rank p = 0.954). On multivariate analysis, neoadjuvant CRT had no impact on DFS when compared to upfront surgery (adjusted HR 0.71, 95%CI 0.18–2.70, p = 0.613), but 61.9% of upfront surgery cases were treated by adjuvant chemo-radiation (adjusted HR 0.41, 95%CI 0.11–1.57, p = 0.196). The only independent predictor of improved DFS was age at diagnosis (adjusted HR 0.95, p = 0.017). Conclusion: CRT should be considered for cT3N0 patients, but its timing (neoadjuvant vs. adjuvant) seems not to affect the disease-free survival in the present cohort of patients.

AB - Purpose: Benefits of neoadjuvant chemo-radiotherapy (CRT) are well known for locally advanced and/or node-positive rectal cancer, but the best timing for CRT has been less explored for cT3N0 patients. The aim of the present study was to compare the 5-year disease-free survival (DFS) probability between neoadjuvant CRT and upfront surgery in patients affected by cT3N0 rectal cancer. Methods: A retrospective review of 105 patients affected by cT3N0 rectal cancer, staged by pelvic magnetic resonance imaging and treated at the National Cancer Institute of Milan between 2011 and 2017, was performed: 42 (40.0%) were treated by neoadjuvant CRT and 63 (60.0%) by upfront surgery. Propensity score matching was performed to avoid selection bias, and Cox multivariate regression was used to analyze outcomes. Results: The 5-year DFS probability was 87.5% in neoadjuvant CRT patients vs. 90.0% in upfront surgery cases (Log-rank p = 0.76). The 5-year loco-regional recurrence-free survival probability was respectively 96.8% vs. 96.3% (Log-rank p = 0.954). On multivariate analysis, neoadjuvant CRT had no impact on DFS when compared to upfront surgery (adjusted HR 0.71, 95%CI 0.18–2.70, p = 0.613), but 61.9% of upfront surgery cases were treated by adjuvant chemo-radiation (adjusted HR 0.41, 95%CI 0.11–1.57, p = 0.196). The only independent predictor of improved DFS was age at diagnosis (adjusted HR 0.95, p = 0.017). Conclusion: CRT should be considered for cT3N0 patients, but its timing (neoadjuvant vs. adjuvant) seems not to affect the disease-free survival in the present cohort of patients.

KW - Adjuvant radiotherapy

KW - Neoadjuvant chemo-radiation therapy

KW - Rectal cancer

KW - Surgery

KW - T3N0

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U2 - 10.1007/s00384-019-03446-4

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JF - International Journal of Colorectal Disease

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