Efficacy of concurrent radiotherapy in patients with locally advanced rectal cancer and synchronous metastasis receiving systemic therapy
BackgroundNeoadjuvant chemoradiotherapy followed by total mesorectal excision is the standard treatment for patients with nonmetastatic locally advanced rectal cancer (LARC). However, for patients with LARC and synchronous metastasis, the optimal treatment strategy and sequence remain inconclusive....
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Frontiers Media S.A.
2023-03-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2023.1099168/full |
| _version_ | 1797856210311970816 |
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| author | Tzu-Chieh Yin Tzu-Chieh Yin Tzu-Chieh Yin Po-Jung Chen Yung-Sung Yeh Yung-Sung Yeh Yung-Sung Yeh Ching-Chun Li Ching-Chun Li Yen-Cheng Chen Yen-Cheng Chen Wei-Chih Su Wei-Chih Su Tsung-Kun Chang Tsung-Kun Chang Tsung-Kun Chang Ching-Wen Huang Ching-Wen Huang Chun-Ming Huang Chun-Ming Huang Chun-Ming Huang Chun-Ming Huang Hsiang-Lin Tsai Hsiang-Lin Tsai Jaw-Yuan Wang Jaw-Yuan Wang Jaw-Yuan Wang Jaw-Yuan Wang Jaw-Yuan Wang Jaw-Yuan Wang |
| author_facet | Tzu-Chieh Yin Tzu-Chieh Yin Tzu-Chieh Yin Po-Jung Chen Yung-Sung Yeh Yung-Sung Yeh Yung-Sung Yeh Ching-Chun Li Ching-Chun Li Yen-Cheng Chen Yen-Cheng Chen Wei-Chih Su Wei-Chih Su Tsung-Kun Chang Tsung-Kun Chang Tsung-Kun Chang Ching-Wen Huang Ching-Wen Huang Chun-Ming Huang Chun-Ming Huang Chun-Ming Huang Chun-Ming Huang Hsiang-Lin Tsai Hsiang-Lin Tsai Jaw-Yuan Wang Jaw-Yuan Wang Jaw-Yuan Wang Jaw-Yuan Wang Jaw-Yuan Wang Jaw-Yuan Wang |
| author_sort | Tzu-Chieh Yin |
| collection | DOAJ |
| description | BackgroundNeoadjuvant chemoradiotherapy followed by total mesorectal excision is the standard treatment for patients with nonmetastatic locally advanced rectal cancer (LARC). However, for patients with LARC and synchronous metastasis, the optimal treatment strategy and sequence remain inconclusive. In the present study, we evaluated the efficacy and safety of concurrent radiotherapy in patients with de novo metastatic rectal cancer who received chemotherapy and targeted therapy.MethodsWe retrospectively reviewed the data of 63 patients with LARC and synchronous metastasis who received intensive therapy at the study hospital between April 2015 and November 2018. The included patients were divided into two groups: RT-CT, those who received systemic chemotherapy with targeted therapy and concurrent radiotherapy (for primary rectal cancer), and CT, those who received only systemic chemotherapy with targeted therapy.ResultsTreatment response was better in the RT-CT group than in the CT group. The rate of primary tumor resection (PTR) was higher in the RT-CT group than in the CT group (71.4% and 42.9%, respectively; P = .0286). The RT-CT group exhibited considerably longer local recurrence-free survival (P = .0453) and progression-free survival (PFS; from 13.3 to 22.5 months) than did the CT group (P = .0091); however, the groups did not differ in terms of overall survival (OS; P = .49). Adverse events were almost similar between the groups, except frequent diarrhea, the prevalence of which was higher in the RT-CT group than in the CT group (59.5% and 23.8%, respectively; P = .0075).ConclusionsIn the era of biologics, radiotherapy may increase the resectability of primary rectal tumors, reducing the risk of locoregional failure and prolonging PFS. Concurrent pelvic radiotherapy may not substantially improve OS, which is indicated by metastasis. Hence, the resection of the distant metastases may be essential for improving long-term OS. To further determine the efficacy of concurrent radiotherapy, additional prospective, randomized studies must combine preoperative pelvic radiotherapy with PTR and metastectomy to treat patients with stage IV LARC. |
| first_indexed | 2024-04-09T20:37:53Z |
| format | Article |
| id | doaj.art-5d7444be5dec42e79094795e633f37cd |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-04-09T20:37:53Z |
| publishDate | 2023-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-5d7444be5dec42e79094795e633f37cd2023-03-30T07:20:58ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2023-03-011310.3389/fonc.2023.10991681099168Efficacy of concurrent radiotherapy in patients with locally advanced rectal cancer and synchronous metastasis receiving systemic therapyTzu-Chieh Yin0Tzu-Chieh Yin1Tzu-Chieh Yin2Po-Jung Chen3Yung-Sung Yeh4Yung-Sung Yeh5Yung-Sung Yeh6Ching-Chun Li7Ching-Chun Li8Yen-Cheng Chen9Yen-Cheng Chen10Wei-Chih Su11Wei-Chih Su12Tsung-Kun Chang13Tsung-Kun Chang14Tsung-Kun Chang15Ching-Wen Huang16Ching-Wen Huang17Chun-Ming Huang18Chun-Ming Huang19Chun-Ming Huang20Chun-Ming Huang21Hsiang-Lin Tsai22Hsiang-Lin Tsai23Jaw-Yuan Wang24Jaw-Yuan Wang25Jaw-Yuan Wang26Jaw-Yuan Wang27Jaw-Yuan Wang28Jaw-Yuan Wang29Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, TaiwanDepartment of Surgery, Kaohsiung Municipal Tatung Hospital, Kaohsiung Medical University, Kaohsiung, TaiwanDivision of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, TaiwanDivision of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, TaiwanDivision of Trauma and Surgical Critical Care, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, TaiwanDepartment of Emergency Medicine, Faculty of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, TaiwanGraduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, TaiwanDivision of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, TaiwanDepartment of Surgery, Kaohsiung Municipal Hsiaokang Hospital, Kaohsiung, TaiwanDivision of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, TaiwanGraduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, TaiwanDivision of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, TaiwanGraduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, TaiwanDivision of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, TaiwanGraduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, TaiwanDepartment of Surgery, Faculty of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, TaiwanDivision of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan0Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan1Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan2Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan3Department of Radiation Oncology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan4Department of Radiation Oncology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, TaiwanDivision of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan0Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, TaiwanDivision of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, TaiwanGraduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan0Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan1Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan5Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan6Pingtung Hospital, Ministry of Health and Welfare, Pingtung, TaiwanBackgroundNeoadjuvant chemoradiotherapy followed by total mesorectal excision is the standard treatment for patients with nonmetastatic locally advanced rectal cancer (LARC). However, for patients with LARC and synchronous metastasis, the optimal treatment strategy and sequence remain inconclusive. In the present study, we evaluated the efficacy and safety of concurrent radiotherapy in patients with de novo metastatic rectal cancer who received chemotherapy and targeted therapy.MethodsWe retrospectively reviewed the data of 63 patients with LARC and synchronous metastasis who received intensive therapy at the study hospital between April 2015 and November 2018. The included patients were divided into two groups: RT-CT, those who received systemic chemotherapy with targeted therapy and concurrent radiotherapy (for primary rectal cancer), and CT, those who received only systemic chemotherapy with targeted therapy.ResultsTreatment response was better in the RT-CT group than in the CT group. The rate of primary tumor resection (PTR) was higher in the RT-CT group than in the CT group (71.4% and 42.9%, respectively; P = .0286). The RT-CT group exhibited considerably longer local recurrence-free survival (P = .0453) and progression-free survival (PFS; from 13.3 to 22.5 months) than did the CT group (P = .0091); however, the groups did not differ in terms of overall survival (OS; P = .49). Adverse events were almost similar between the groups, except frequent diarrhea, the prevalence of which was higher in the RT-CT group than in the CT group (59.5% and 23.8%, respectively; P = .0075).ConclusionsIn the era of biologics, radiotherapy may increase the resectability of primary rectal tumors, reducing the risk of locoregional failure and prolonging PFS. Concurrent pelvic radiotherapy may not substantially improve OS, which is indicated by metastasis. Hence, the resection of the distant metastases may be essential for improving long-term OS. To further determine the efficacy of concurrent radiotherapy, additional prospective, randomized studies must combine preoperative pelvic radiotherapy with PTR and metastectomy to treat patients with stage IV LARC.https://www.frontiersin.org/articles/10.3389/fonc.2023.1099168/fullmetastatic rectal cancerlocally advanced rectal cancerconcurrent radiotherapyprimary tumor resection (PTR)systemic chemotherapysystemic targeted therapy |
| spellingShingle | Tzu-Chieh Yin Tzu-Chieh Yin Tzu-Chieh Yin Po-Jung Chen Yung-Sung Yeh Yung-Sung Yeh Yung-Sung Yeh Ching-Chun Li Ching-Chun Li Yen-Cheng Chen Yen-Cheng Chen Wei-Chih Su Wei-Chih Su Tsung-Kun Chang Tsung-Kun Chang Tsung-Kun Chang Ching-Wen Huang Ching-Wen Huang Chun-Ming Huang Chun-Ming Huang Chun-Ming Huang Chun-Ming Huang Hsiang-Lin Tsai Hsiang-Lin Tsai Jaw-Yuan Wang Jaw-Yuan Wang Jaw-Yuan Wang Jaw-Yuan Wang Jaw-Yuan Wang Jaw-Yuan Wang Efficacy of concurrent radiotherapy in patients with locally advanced rectal cancer and synchronous metastasis receiving systemic therapy Frontiers in Oncology metastatic rectal cancer locally advanced rectal cancer concurrent radiotherapy primary tumor resection (PTR) systemic chemotherapy systemic targeted therapy |
| title | Efficacy of concurrent radiotherapy in patients with locally advanced rectal cancer and synchronous metastasis receiving systemic therapy |
| title_full | Efficacy of concurrent radiotherapy in patients with locally advanced rectal cancer and synchronous metastasis receiving systemic therapy |
| title_fullStr | Efficacy of concurrent radiotherapy in patients with locally advanced rectal cancer and synchronous metastasis receiving systemic therapy |
| title_full_unstemmed | Efficacy of concurrent radiotherapy in patients with locally advanced rectal cancer and synchronous metastasis receiving systemic therapy |
| title_short | Efficacy of concurrent radiotherapy in patients with locally advanced rectal cancer and synchronous metastasis receiving systemic therapy |
| title_sort | efficacy of concurrent radiotherapy in patients with locally advanced rectal cancer and synchronous metastasis receiving systemic therapy |
| topic | metastatic rectal cancer locally advanced rectal cancer concurrent radiotherapy primary tumor resection (PTR) systemic chemotherapy systemic targeted therapy |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2023.1099168/full |
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