Surveillance,Epidemiology, and End Results-based analysis of the impact of preoperative or postoperative radiotherapy on survival outcomes for T3N0 rectal cancer |
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| Affiliation: | 1. Department of Radiation Oncology, Stich Radiation Center, Weill Cornell Medical College of Cornell University, New York, NY, United States;2. Department of Surgery, Weill Cornell Medical College of Cornell University, New York, NY, United States;1. Department of Computer Science, Brock University, St. Catharines, Canada;2. Osram GmbH, Munich, Germany;1. Department of Colorectal Surgery, Royal Marsden Hospital, Fulham Road, London, UK;2. Division of Surgery, Imperial College, Chelsea and Westminster Campus, London, UK;3. Division of Colorectal Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, USA;4. Department of Surgery, University of Liverpool, Liverpool, UK;1. Departamento de Ingeniería de Proyectos, CUCEI, Universidad de Guadalajara, J. Guadalupe Zuno 48, Los Belenes, Zapopan, Jal. 45101, Mexico;2. Instituto de Física, UNAM, Avenida de la Investigación S/N, Coyoacán, México, D.F. 04510, Mexico;3. ESIME-Z, Instituto Politécnico Nacional, ALM Zacatenco, México, D.F. 07738, Mexico;1. Anses, Laboratoire de Ploufragan-Plouzané, Unité Virologie et Immunologie Porcines, Zoopôle Les Croix, BP53, 22440 Ploufragan, France;2. Université Européenne de Bretagne, 35000 Rennes, France;3. Friedrich-Loeffler-Institute, Institute of Diagnostic Virology, Suedufer 10, 17493 Greifswald-Insel Riems, Germany;4. National Food Chain Safety Office, Directorate of Veterinary Medicinal Products, Immunological Department, 8 Szallas Street, 1107 Budapest, Hungary;5. CODA-CERVA, Interactions and Surveillance, 99 Groeselenberg, B-1180 Brussels, Belgium |
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| Abstract: | Purpose: Preoperative chemoradiation has been established as standard of care for T3/T4 node-positive rectal cancer. Recent work, however, has called into question the overall benefit of radiation for tumors with lower risk characteristics, particularly T3N0 rectal cancers. We retrospectively analyzed T3N0 rectal cancer patients and examined how outcomes differed according to the sequence of treatment received. Methods: The Surveillance, Epidemiology, and End Results (SEER) database was used to analyze T3N0 rectal cancer cases diagnosed between 1998 and 2008. Treatment consisted of surgery alone (No RT), preoperative radiation followed by surgery (Neo-Adjuvant RT), or surgery followed by postoperative radiation (Adjuvant RT). Demographic and tumor characteristics of the three groups were compared using t-tests for the comparison of means. Survival information from the SEER database was utilized to estimate cause-specific survival (CSS) and to generate Kaplan–Meier survival curves. Multivariate analysis (MVA) of features associated with outcomes was conducted using Cox proportional hazards regression models with Adjuvant RT, Neo-Adjuvant RT, No RT, histological grade, tumor size, year of diagnosis, and demographic characteristics as covariates. Results: 10-Year CSS estimates were 66.1% (95% CI 62.3–69.6%; P = 0.02), 73.5% (95% CI 68.9–77.5%; P = 0.02), and 76.1% (95% CI 72.4–79.4%; P = 0.02), for No RT, Neo-Adjuvant RT, and Adjuvant RT, respectively. On MVA, Adjuvant RT (HR = 0.688; 95% CI, 0.578–0.819; P < 0.001) was associated with significantly decreased risk for cancer death. By contrast, Neo-Adjuvant RT was not significantly associated with improved cancer survival (HR = 0.863; 95% CI, 0.715–1.043; P = 0.127). Conclusion: Adjuvant RT was associated with significantly higher CSS when compared with surgery alone, while the benefit of Neo-Adjuvant RT was not significant. This indicates that surgery followed by Adjuvant RT may still be an important treatment plan for T3N0 rectal cancer with potentially significant survival advantages over other treatment sequences. |
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| Keywords: | Rectal cancer T3N0 SEER Radiation Pre-operative Post-operative Outcomes |
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