Preoperative radiotherapy improves survival for patients undergoing total mesorectal excision for stage T3 low rectal cancers

Conor P. Delaney, Ian C. Lavery, Antonio Brenner, Jeffrey Hammel, Anthony J. Senagore, Robert B. Noone, Victor W. Fazio

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Objective: To examine the effect of preoperative radiotherapy (PRT) on patients who undergo rectal resection with total mesorectal excision (TME) for stage T3 low rectal cancers. Summary Background Data: Evidence for the value of PRT before rectal cancer surgery is weakened by variability in the use of TME. Many surgeons have concluded that PRT is unnecessary for small rectal tumors if TME is performed, but there are no prospective data to support this opinion. Methods: Since 1980, 2,200 patients with rectal cancer have been enrolled in a prospective database. Of these, 259 underwent curative anterior or abdominoperineal resection with TME for pathologically confirmed T3 lesions within 8 cm of the anal verge. Patients were grouped by receiving PRT (n = 92) or not receiving PRT (n = 167). Five-year overall survival and 5-year local recurrence rates were evaluated. Results: Overall survival was increased from 52% in patients not receiving PRT to 63% in those receiving PRT. PRT increased overall survival for node-negative patients from 58% to 82%, with no benefit for node-positive patients. There was no significant difference in local recurrence rates. When categorized by tumor size, there was no difference in overall survival or local recurrence for 0- to 2-cm tumors or those larger than 5 cm, but PRT increased overall survival from 50% to 72% for patients with 2- to 5-cm tumors. Similar results were observed for patients with tumors staged as T3 on preoperative endoluminal ultrasound. Conclusions: Patients with pT3 low rectal cancers undergoing resection with TME have an improved survival with PRT. The effect is most beneficial for patients with node-negative and 2- to 5-cm tumors, although this group may include larger and node-positive tumors that have been downstaged by PRT. PRT should be advocated for all patients with T3 rectal cancers less than 8 cm from the anal verge, even if the surgery includes a properly performed TME.

Original languageEnglish (US)
Pages (from-to)203-207
Number of pages5
JournalAnnals of Surgery
Volume236
Issue number2
DOIs
StatePublished - 2002
Externally publishedYes

Fingerprint

Rectal Neoplasms
Radiotherapy
Survival
Neoplasms
Recurrence
Databases

ASJC Scopus subject areas

  • Surgery

Cite this

Delaney, C. P., Lavery, I. C., Brenner, A., Hammel, J., Senagore, A. J., Noone, R. B., & Fazio, V. W. (2002). Preoperative radiotherapy improves survival for patients undergoing total mesorectal excision for stage T3 low rectal cancers. Annals of Surgery, 236(2), 203-207. https://doi.org/10.1097/00000658-200208000-00008

Preoperative radiotherapy improves survival for patients undergoing total mesorectal excision for stage T3 low rectal cancers. / Delaney, Conor P.; Lavery, Ian C.; Brenner, Antonio; Hammel, Jeffrey; Senagore, Anthony J.; Noone, Robert B.; Fazio, Victor W.

In: Annals of Surgery, Vol. 236, No. 2, 2002, p. 203-207.

Research output: Contribution to journalArticle

Delaney, Conor P. ; Lavery, Ian C. ; Brenner, Antonio ; Hammel, Jeffrey ; Senagore, Anthony J. ; Noone, Robert B. ; Fazio, Victor W. / Preoperative radiotherapy improves survival for patients undergoing total mesorectal excision for stage T3 low rectal cancers. In: Annals of Surgery. 2002 ; Vol. 236, No. 2. pp. 203-207.
@article{eda3e601e7994b5ca3bba75fe3929d59,
title = "Preoperative radiotherapy improves survival for patients undergoing total mesorectal excision for stage T3 low rectal cancers",
abstract = "Objective: To examine the effect of preoperative radiotherapy (PRT) on patients who undergo rectal resection with total mesorectal excision (TME) for stage T3 low rectal cancers. Summary Background Data: Evidence for the value of PRT before rectal cancer surgery is weakened by variability in the use of TME. Many surgeons have concluded that PRT is unnecessary for small rectal tumors if TME is performed, but there are no prospective data to support this opinion. Methods: Since 1980, 2,200 patients with rectal cancer have been enrolled in a prospective database. Of these, 259 underwent curative anterior or abdominoperineal resection with TME for pathologically confirmed T3 lesions within 8 cm of the anal verge. Patients were grouped by receiving PRT (n = 92) or not receiving PRT (n = 167). Five-year overall survival and 5-year local recurrence rates were evaluated. Results: Overall survival was increased from 52{\%} in patients not receiving PRT to 63{\%} in those receiving PRT. PRT increased overall survival for node-negative patients from 58{\%} to 82{\%}, with no benefit for node-positive patients. There was no significant difference in local recurrence rates. When categorized by tumor size, there was no difference in overall survival or local recurrence for 0- to 2-cm tumors or those larger than 5 cm, but PRT increased overall survival from 50{\%} to 72{\%} for patients with 2- to 5-cm tumors. Similar results were observed for patients with tumors staged as T3 on preoperative endoluminal ultrasound. Conclusions: Patients with pT3 low rectal cancers undergoing resection with TME have an improved survival with PRT. The effect is most beneficial for patients with node-negative and 2- to 5-cm tumors, although this group may include larger and node-positive tumors that have been downstaged by PRT. PRT should be advocated for all patients with T3 rectal cancers less than 8 cm from the anal verge, even if the surgery includes a properly performed TME.",
author = "Delaney, {Conor P.} and Lavery, {Ian C.} and Antonio Brenner and Jeffrey Hammel and Senagore, {Anthony J.} and Noone, {Robert B.} and Fazio, {Victor W.}",
year = "2002",
doi = "10.1097/00000658-200208000-00008",
language = "English (US)",
volume = "236",
pages = "203--207",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Preoperative radiotherapy improves survival for patients undergoing total mesorectal excision for stage T3 low rectal cancers

AU - Delaney, Conor P.

AU - Lavery, Ian C.

AU - Brenner, Antonio

AU - Hammel, Jeffrey

AU - Senagore, Anthony J.

AU - Noone, Robert B.

AU - Fazio, Victor W.

PY - 2002

Y1 - 2002

N2 - Objective: To examine the effect of preoperative radiotherapy (PRT) on patients who undergo rectal resection with total mesorectal excision (TME) for stage T3 low rectal cancers. Summary Background Data: Evidence for the value of PRT before rectal cancer surgery is weakened by variability in the use of TME. Many surgeons have concluded that PRT is unnecessary for small rectal tumors if TME is performed, but there are no prospective data to support this opinion. Methods: Since 1980, 2,200 patients with rectal cancer have been enrolled in a prospective database. Of these, 259 underwent curative anterior or abdominoperineal resection with TME for pathologically confirmed T3 lesions within 8 cm of the anal verge. Patients were grouped by receiving PRT (n = 92) or not receiving PRT (n = 167). Five-year overall survival and 5-year local recurrence rates were evaluated. Results: Overall survival was increased from 52% in patients not receiving PRT to 63% in those receiving PRT. PRT increased overall survival for node-negative patients from 58% to 82%, with no benefit for node-positive patients. There was no significant difference in local recurrence rates. When categorized by tumor size, there was no difference in overall survival or local recurrence for 0- to 2-cm tumors or those larger than 5 cm, but PRT increased overall survival from 50% to 72% for patients with 2- to 5-cm tumors. Similar results were observed for patients with tumors staged as T3 on preoperative endoluminal ultrasound. Conclusions: Patients with pT3 low rectal cancers undergoing resection with TME have an improved survival with PRT. The effect is most beneficial for patients with node-negative and 2- to 5-cm tumors, although this group may include larger and node-positive tumors that have been downstaged by PRT. PRT should be advocated for all patients with T3 rectal cancers less than 8 cm from the anal verge, even if the surgery includes a properly performed TME.

AB - Objective: To examine the effect of preoperative radiotherapy (PRT) on patients who undergo rectal resection with total mesorectal excision (TME) for stage T3 low rectal cancers. Summary Background Data: Evidence for the value of PRT before rectal cancer surgery is weakened by variability in the use of TME. Many surgeons have concluded that PRT is unnecessary for small rectal tumors if TME is performed, but there are no prospective data to support this opinion. Methods: Since 1980, 2,200 patients with rectal cancer have been enrolled in a prospective database. Of these, 259 underwent curative anterior or abdominoperineal resection with TME for pathologically confirmed T3 lesions within 8 cm of the anal verge. Patients were grouped by receiving PRT (n = 92) or not receiving PRT (n = 167). Five-year overall survival and 5-year local recurrence rates were evaluated. Results: Overall survival was increased from 52% in patients not receiving PRT to 63% in those receiving PRT. PRT increased overall survival for node-negative patients from 58% to 82%, with no benefit for node-positive patients. There was no significant difference in local recurrence rates. When categorized by tumor size, there was no difference in overall survival or local recurrence for 0- to 2-cm tumors or those larger than 5 cm, but PRT increased overall survival from 50% to 72% for patients with 2- to 5-cm tumors. Similar results were observed for patients with tumors staged as T3 on preoperative endoluminal ultrasound. Conclusions: Patients with pT3 low rectal cancers undergoing resection with TME have an improved survival with PRT. The effect is most beneficial for patients with node-negative and 2- to 5-cm tumors, although this group may include larger and node-positive tumors that have been downstaged by PRT. PRT should be advocated for all patients with T3 rectal cancers less than 8 cm from the anal verge, even if the surgery includes a properly performed TME.

UR - http://www.scopus.com/inward/record.url?scp=0036328677&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036328677&partnerID=8YFLogxK

U2 - 10.1097/00000658-200208000-00008

DO - 10.1097/00000658-200208000-00008

M3 - Article

C2 - 12170025

AN - SCOPUS:0036328677

VL - 236

SP - 203

EP - 207

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 2

ER -