Postoperative radio-chemotherapy for rectal cancer: A retrospective analysis from a tertiary referral hospital

Ewa Wasilewska-Teśluk; Monika Rucińska; Karolina Osowiecka; Iwona Ryniewicz-Zander; Beata Czeremszyńska; Krzysztof Gliński; Lucyna Kępka

doi:10.1016/j.rpor.2020.05.002

Postoperative radio-chemotherapy for rectal cancer: A retrospective analysis from a tertiary referral hospital

Rep Pract Oncol Radiother. 2020 Jul-Aug;25(4):612-618. doi: 10.1016/j.rpor.2020.05.002. Epub 2020 May 23.

Authors

Ewa Wasilewska-Teśluk^{1

2}, Monika Rucińska^{2

3}, Karolina Osowiecka^{4

5}, Iwona Ryniewicz-Zander⁶, Beata Czeremszyńska³, Krzysztof Gliński¹, Lucyna Kępka³

Affiliations

¹ Independent Public Health Care Facility of the Ministry of the Interior and Warmian & Masurian Oncology Center, Radiotherapy Department, Olsztyn, Poland.
² Department of Oncology, University of Warmia & Mazury, Olsztyn, Poland.
³ Military Institute of Medicine, Warsaw, Poland.
⁴ Department of Public Health, University of Warmia & Mazury, Olsztyn, Poland.
⁵ Department of Public Health, Medical University of Warsaw, Warsaw, Poland.
⁶ Regional Hospital of Elbląg, Elbląg, Poland.

Abstract

Aim: To report results of postoperative radio-chemotherapy (RT-CHT) for rectal cancer (RC).

Background: Total mesorectal excision (TME) is an essential treatment method in rectal cancer (RC). Perioperative radiotherapy in locally advanced RC improves loco-regional free survival (LRFS). Preoperative radiotherapy is a preferred option; however, some patients are not referred for it. In case of the risk of loco-regional failure postoperative radio-chemotherapy (RT-CHT) is indicated.

Material and methods: Between 2004 and 2010, 182 patients with pathological stage II-III RC (TME performed - 41%, resection R0 - 88%, circumferential resection margin evaluated - 55.5% and was above 2 mm in 66% of them) received postoperative RT-CHT in our institution. Overall survival (OS) and LRFS were estimated with the Kaplan-Meier method. Univariate and multivariate analysis were performed to compare the impact of prognostic factors on survival.

Results: Five-year OS and LRFS rates were 63% and 85%, respectively. Loco-regional recurrence and isolated distant metastases rates were 11.5% and 19%, respectively. Multivariate analysis showed stage (III vs. II), HR: 2.3 (95% confidence interval [CI]: 1.4-3.8), p = 0.0001; extent of resection (R1-2 vs. R0), HR: 2.14 (95%CI: 1.14-3.99), p = 0.017, and age (>65 vs. ≤65 years), HR: 1.66 (95%CI: 1.06-2.61), p = 0.027 as prognostic factors for OS. Extent of resection (R1-2 vs. R0), HR: 3.65 (95%CI: 1.41-9.43), p = 0.008 had significant impact on LRFS.

Conclusion: Despite a suboptimal quality of surgery and pathological reports, the outcome in our series is close to that reported in the literature. We confirm a strong impact of the extent of resection on patient's outcome, which confirms the pivotal role of surgery in the management of RC.

Keywords: Postoperative radio-chemotherapy; Rectal cancer; Total mesorectal excision.