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Trends and outcome of neoadjuvant treatment for rectal cancer: A retrospective analysis and critical assessment of a 10-year prospective national registry on behalf of the Spanish Rectal Cancer Project

2020; Elsevier BV; Volume: 47; Issue: 2 Linguagem: Inglês

10.1016/j.ejso.2020.04.056

1532-2157

Gianluca Pellino, Rafael Alós, Sebastiano Biondo, Antonio Codina Cazador, José M. Enríquez–Navascués, Eloy Espín, José Vicente Roig‐Vila, Andrés Cervantes, Eduardo García‐Granero, R Adell Carceller, Juan Guillermo Ais Conde, Evelio Alonso Alonso, Antonio Amaya Cortijo, Antonio Arroyo Sebastián, Pedro Barra Baños, Ricard Batlle Solé, Juan Carlos Bernal Sprekelsen, Sebastiano Biondo, Francisco Javier Blanco González, S Vázquez Blanco, Jesús Bollo, Nieves Cáceres Alvarado, Ignasi Camps Ausàs, Ramón Cantero Cid, José Antonio Carmona Saez, Enrique Núñez, Luis-Cristóbal Capitán-Morales, Guillermo Carreño Villarreal, Jesús Cifuentes Tébar, Miguel A. Lozano, Antonio Codina Cazador, Juan de Dios Franco Osorio, María de la Vega Olías, Mario de Miguel Velasco, Sergio Rodrigo del Valle, José G. Díaz Mejías, J. M. Díaz Pavón, Javier Díe Trill, J.L. Domínguez Tristancho, Paula Dujovne Lindenbaum, José Errasti Alustiza, Alejandro Espí Macías, Eloy Espín, Rafael Estevan, Alfredo M. Estevez Diz, Luis Flores-Padilla, Doménico Fraccalvieri, Alessandro Garcea, Mauricio García Alonso, M. Botella, Maria José García Coret, Alfonso García Fadrique, José-María García-García, J. García García, Eduardo García‐Granero, Jesus Alvarez, José Gomez Barbadillo, Fernando Gris, Verónica Gumbau, Javier Gutierrez, Pilar Hernández Casanovas, Daniel Huerga Álvarez, Ana M. Huidobro Piriz, Francisco Javier Jiménez Miramón, Ana Lage Laredo, Alberto Lamiquiz Vallejo, Félix Lluís Casajuana, Manuel López Lara, Juan Mompeán, María Victoría Maestre, Eva Martí Martínez, M. Martinez, Javier Martínez Alegre, Gabriel Martínez Gallego, Roberto Martinez Pardavila, Olga Maseda Díaz, Mónica Millan Schedling, Benito Mirón, Jose M. Abad, José A. Múgica Martinera, Francisco Olivet Pujol, Mónica Orelogio Orozco, Luis Ortiz de Zárate, Rosana Palasí Gimenez, Natividad Palencia García, P. Palma, Alberto Parajó Calvo, Jesús Paredes Cotoré, Carlos Pastor Idoate, Miguel Pera Román, Francisco Pérez Benítez, José A. Pérez García, Marta Piñol Pascual, I. Nieto, Ricardo Rada Morgades, Mónica Reig Pérez, Ángel Reina Duarte, Didac Ribé Serrat, Xavier Rodamilans, María Dolores Carmona-Luque, Marcos Rodriguez Martin, Francisco Romero Aceituno, Jesús Salas Martínez, Ginés Sánchez de la Villa, Inmaculada Segura Jiménez, José Enrique Sierra Grañón, Amparo Solana Bueno, Albert Sueiras Gil, Teresa Torres‐Sánchez, Natalia Uribe Quintana, Javier Valdés-Hernández, Fancesc Vallribera, V. Viciano Pascual,

Colorectal Cancer Screening and Detection

Preoperative treatment and adequate surgery increase local control in rectal cancer. However, modalities and indications for neoadjuvant treatment may be controversial. Aim of this study was to assess the trends of preoperative treatment and outcomes in patients with rectal cancer included in the Rectal Cancer Registry of the Spanish Associations of Surgeons.This is a STROBE-compliant retrospective analysis of a prospective database. All patients operated on with curative intention included in the Rectal Cancer Registry were included. Analyses were performed to compare the use of neoadjuvant/adjuvant treatment in three timeframes: I)2006-2009; II)2010-2013; III)2014-2017. Survival analyses were run for 3-year survival in timeframes I-II.Out of 14,391 patients,8871 (61.6%) received neoadjuvant treatment. Long-course chemo/radiotherapy was the most used approach (79.9%), followed by short-course radiotherapy ± chemotherapy (7.6%). The use of neoadjuvant treatment for cancer of the upper third (15-11 cm) increased over time (31.5%vs 34.5%vs 38.6%,p = 0.0018). The complete regression rate slightly increased over time (15.6% vs 16% vs 18.5%; p = 0.0093); the proportion of patients with involved circumferential resection margins (CRM) went down from 8.2% to 7.3%and 5.5% (p = 0.0004). Neoadjuvant treatment significantly decreased positive CRM in lower third tumors (OR 0.71, 0.59-0.87, Cochrane-Mantel-Haenszel P = 0.0008). Most ypN0 patients also received adjuvant therapy. In MR-defined stage III patients, preoperative treatment was associated with significantly longer local-recurrence-free survival (p < 0.0001), and cancer-specific survival (p < 0.0001). The survival benefit was smaller in upper third cancers.There was an increasing trend and a potential overuse of neoadjuvant treatment in cancer of the upper rectum. Most ypN0 patients received postoperative treatment. Involvement of CRM in lower third tumors was reduced after neoadjuvant treatment. Stage III and MRcN + benefited the most.