Neoadjuvant chemoradiation for rectal cancer

Analysis of clinical outcomes from a 13-year institutional experience

Mark W. Onaitis, Robert B. Noone, Matthew Hartwig, Herbert Hurwitz, Michael Morse, Paul Jowell, Kevin McGrath, Catherine Lee, Mitchell S. Anscher, Bryan Clary, Christopher Mantyh, Theodore N. Pappas, Kirk Ludwig, Hilliard F. Seigler, Douglas Tyler

Research output: Contribution to journalArticle

121 Citations (Scopus)

Abstract

Objective: To examine clinical outcomes in patients receiving neoadjuvant chemoradiation for locally advanced rectal adenocarcinoma. Summary Background Data: Preoperative radiation therapy, either alone or in combination with 5-fluorouracil-based chemotherapy, has proven both safe and effective in the treatment of rectal cancer. However, data are lacking regarding which subgroups of patients benefit from the therapy in terms of decreased local recurrence and increased survival rates. Methods: A retrospective chart review was performed on 141 consecutive patients who received neoadjuvant chemoradiation (5fluorouracil ± cisplatin and 4,500-5,040 cgy) for biopsyproven locally advanced adenocarcinoma of the rectum. Surgery was performed 4 to 8 weeks after completion of chemoradiation. Standard statistical methods were used to analyze recurrence and survival. Results: Median follow-up was 27 months, and mean age was 59 years (range 28-81). Mean tumor distance from the anal verge was 6 cm (range 1-15). Of those staged before surgery with endorectal ultrasound or magnetic resonance imaging, 57% of stage II patients and 82% of stage III patients were downstaged. The chemotherapeutic regimens were well tolerated, and resections were performed on 140 patients. The percentage of sphincter-sparing procedures increased from 20% before 1996 to 76% after 1996. On pathologic analysis, 24% of specimens were TO. However, postoperative pathologic T stage had no effect on either recurrence or survival. Positive lymph node status predicted increased local recurrence and decreased survival. Conclusions: Neoadjuvant chemoradiation is safe, effective, and well tolerated. Postoperative lymph node status is the only independent predictor of recurrence and survival.

Original languageEnglish (US)
Pages (from-to)778-785
Number of pages8
JournalAnnals of Surgery
Volume233
Issue number6
DOIs
StatePublished - 2001
Externally publishedYes

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Rectal Neoplasms
Recurrence
Survival
Adenocarcinoma
Lymph Nodes
Survival Analysis
Rectum
Fluorouracil
Cisplatin
Radiotherapy
Survival Rate
Magnetic Resonance Imaging
Drug Therapy
Therapeutics
Neoplasms

ASJC Scopus subject areas

  • Surgery

Cite this

Neoadjuvant chemoradiation for rectal cancer : Analysis of clinical outcomes from a 13-year institutional experience. / Onaitis, Mark W.; Noone, Robert B.; Hartwig, Matthew; Hurwitz, Herbert; Morse, Michael; Jowell, Paul; McGrath, Kevin; Lee, Catherine; Anscher, Mitchell S.; Clary, Bryan; Mantyh, Christopher; Pappas, Theodore N.; Ludwig, Kirk; Seigler, Hilliard F.; Tyler, Douglas.

In: Annals of Surgery, Vol. 233, No. 6, 2001, p. 778-785.

Research output: Contribution to journalArticle

Onaitis, MW, Noone, RB, Hartwig, M, Hurwitz, H, Morse, M, Jowell, P, McGrath, K, Lee, C, Anscher, MS, Clary, B, Mantyh, C, Pappas, TN, Ludwig, K, Seigler, HF & Tyler, D 2001, 'Neoadjuvant chemoradiation for rectal cancer: Analysis of clinical outcomes from a 13-year institutional experience', Annals of Surgery, vol. 233, no. 6, pp. 778-785. https://doi.org/10.1097/00000658-200106000-00007
Onaitis, Mark W. ; Noone, Robert B. ; Hartwig, Matthew ; Hurwitz, Herbert ; Morse, Michael ; Jowell, Paul ; McGrath, Kevin ; Lee, Catherine ; Anscher, Mitchell S. ; Clary, Bryan ; Mantyh, Christopher ; Pappas, Theodore N. ; Ludwig, Kirk ; Seigler, Hilliard F. ; Tyler, Douglas. / Neoadjuvant chemoradiation for rectal cancer : Analysis of clinical outcomes from a 13-year institutional experience. In: Annals of Surgery. 2001 ; Vol. 233, No. 6. pp. 778-785.
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abstract = "Objective: To examine clinical outcomes in patients receiving neoadjuvant chemoradiation for locally advanced rectal adenocarcinoma. Summary Background Data: Preoperative radiation therapy, either alone or in combination with 5-fluorouracil-based chemotherapy, has proven both safe and effective in the treatment of rectal cancer. However, data are lacking regarding which subgroups of patients benefit from the therapy in terms of decreased local recurrence and increased survival rates. Methods: A retrospective chart review was performed on 141 consecutive patients who received neoadjuvant chemoradiation (5fluorouracil ± cisplatin and 4,500-5,040 cgy) for biopsyproven locally advanced adenocarcinoma of the rectum. Surgery was performed 4 to 8 weeks after completion of chemoradiation. Standard statistical methods were used to analyze recurrence and survival. Results: Median follow-up was 27 months, and mean age was 59 years (range 28-81). Mean tumor distance from the anal verge was 6 cm (range 1-15). Of those staged before surgery with endorectal ultrasound or magnetic resonance imaging, 57{\%} of stage II patients and 82{\%} of stage III patients were downstaged. The chemotherapeutic regimens were well tolerated, and resections were performed on 140 patients. The percentage of sphincter-sparing procedures increased from 20{\%} before 1996 to 76{\%} after 1996. On pathologic analysis, 24{\%} of specimens were TO. However, postoperative pathologic T stage had no effect on either recurrence or survival. Positive lymph node status predicted increased local recurrence and decreased survival. Conclusions: Neoadjuvant chemoradiation is safe, effective, and well tolerated. Postoperative lymph node status is the only independent predictor of recurrence and survival.",
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T1 - Neoadjuvant chemoradiation for rectal cancer

T2 - Analysis of clinical outcomes from a 13-year institutional experience

AU - Onaitis, Mark W.

AU - Noone, Robert B.

AU - Hartwig, Matthew

AU - Hurwitz, Herbert

AU - Morse, Michael

AU - Jowell, Paul

AU - McGrath, Kevin

AU - Lee, Catherine

AU - Anscher, Mitchell S.

AU - Clary, Bryan

AU - Mantyh, Christopher

AU - Pappas, Theodore N.

AU - Ludwig, Kirk

AU - Seigler, Hilliard F.

AU - Tyler, Douglas

PY - 2001

Y1 - 2001

N2 - Objective: To examine clinical outcomes in patients receiving neoadjuvant chemoradiation for locally advanced rectal adenocarcinoma. Summary Background Data: Preoperative radiation therapy, either alone or in combination with 5-fluorouracil-based chemotherapy, has proven both safe and effective in the treatment of rectal cancer. However, data are lacking regarding which subgroups of patients benefit from the therapy in terms of decreased local recurrence and increased survival rates. Methods: A retrospective chart review was performed on 141 consecutive patients who received neoadjuvant chemoradiation (5fluorouracil ± cisplatin and 4,500-5,040 cgy) for biopsyproven locally advanced adenocarcinoma of the rectum. Surgery was performed 4 to 8 weeks after completion of chemoradiation. Standard statistical methods were used to analyze recurrence and survival. Results: Median follow-up was 27 months, and mean age was 59 years (range 28-81). Mean tumor distance from the anal verge was 6 cm (range 1-15). Of those staged before surgery with endorectal ultrasound or magnetic resonance imaging, 57% of stage II patients and 82% of stage III patients were downstaged. The chemotherapeutic regimens were well tolerated, and resections were performed on 140 patients. The percentage of sphincter-sparing procedures increased from 20% before 1996 to 76% after 1996. On pathologic analysis, 24% of specimens were TO. However, postoperative pathologic T stage had no effect on either recurrence or survival. Positive lymph node status predicted increased local recurrence and decreased survival. Conclusions: Neoadjuvant chemoradiation is safe, effective, and well tolerated. Postoperative lymph node status is the only independent predictor of recurrence and survival.

AB - Objective: To examine clinical outcomes in patients receiving neoadjuvant chemoradiation for locally advanced rectal adenocarcinoma. Summary Background Data: Preoperative radiation therapy, either alone or in combination with 5-fluorouracil-based chemotherapy, has proven both safe and effective in the treatment of rectal cancer. However, data are lacking regarding which subgroups of patients benefit from the therapy in terms of decreased local recurrence and increased survival rates. Methods: A retrospective chart review was performed on 141 consecutive patients who received neoadjuvant chemoradiation (5fluorouracil ± cisplatin and 4,500-5,040 cgy) for biopsyproven locally advanced adenocarcinoma of the rectum. Surgery was performed 4 to 8 weeks after completion of chemoradiation. Standard statistical methods were used to analyze recurrence and survival. Results: Median follow-up was 27 months, and mean age was 59 years (range 28-81). Mean tumor distance from the anal verge was 6 cm (range 1-15). Of those staged before surgery with endorectal ultrasound or magnetic resonance imaging, 57% of stage II patients and 82% of stage III patients were downstaged. The chemotherapeutic regimens were well tolerated, and resections were performed on 140 patients. The percentage of sphincter-sparing procedures increased from 20% before 1996 to 76% after 1996. On pathologic analysis, 24% of specimens were TO. However, postoperative pathologic T stage had no effect on either recurrence or survival. Positive lymph node status predicted increased local recurrence and decreased survival. Conclusions: Neoadjuvant chemoradiation is safe, effective, and well tolerated. Postoperative lymph node status is the only independent predictor of recurrence and survival.

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SP - 778

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JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 6

ER -