Preoperative radiotherapy combined with capecitabine chemotherapy in Chinese patients with locally advanced rectal cancer

Risk Factors for Severe Complications After Laparoscopic Surgery for T3 or T4 Rectal Cancer for Chinese Patients: Experience from a Single Center

Background

Patients with rectal cancer are usually at advanced stage with or beyond serosa invasion in China. Severe complications after laparoscopic rectal surgery leads to prolonged hospitalization and high medical cost. This study aimed to explore risk factors for severe complications after laparoscopic surgery of T3 or T4 rectal cancer.

Material/Methods

A total of 287 patients diagnosed with T3 or T4 rectal cancer were enrolled from the Department of Gastrointestinal Surgery of Anhui Provincial Hospital from February 2012 to February 2017. Univariate analysis and multivariable logistic regression model were used to analyze the risk factors for severe complications (Clavien-Dindo grade ≥III) after laparoscopic surgery.

Results

Eighteen patients (6.25%) had severe complications; 15 patients were categorized as Clavien-Dindo grade III, and 3 patients were categorized as Clavien-Dindo grade IV. Univariate analysis showed that male gender, high preoperative white blood cells (WBC), diabetes mellitus, pulmonary dysfunction, and tumor distance from anus were associated with increased risk of severe complications after laparoscopic surgery for rectal cancer. Multivariate analysis showed that preoperative WBC ≥6.9×10⁹/L (OR=5.54 (1.58–19.45), P=0.008), diabetes mellitus (OR=13.07 (3.31–51.67), P=0.000) and pulmonary dysfunction (OR=7.75 (1.69–35.63), P=0.008) were independent risk factors for postoperative severe complications.

Conclusions

Preoperative high white blood cells, diabetes mellitus and pulmonary dysfunction were independent risk factors for severe complications after laparoscopic surgery for T3 or T4 rectal cancer.

Association between dose-volume parameters and acute bone marrow suppression in rectal cancer patients treated with concurrent chemoradiotherapy

Concurrent chemoradiotherapy is one of the main treatments for rectal cancer. Bone marrow suppression is one of the critical factors that affect the progress of radiotherapy. We aimed to explore the association of incidence of acute bone marrow suppression with dose-volume parameters of pelvic bone marrow among rectal cancer patients with concurrent chemoradiotherapy. We retrospectively analyzed 50 rectal cancer patients for multivariate logistic regression analyses. Three subdomains of pelvic bone marrow (PBM), bilateral ilium (IBM), lower pelvis (LPBM), and lumbosacral spine (LSBM) were assigned. The radiation dose-volume parameters from the three subdomains and the whole pelvis were evaluated. Compared to Grade 0-1 leukopenia patients, ≥Grade 2 leukopenia patients exhibited significantly higher levels of IBM V₂₀, V₂₅, V₃₅, mean dose (Dmean), LPBM V₂₀, V₂₅, V₃₀, LSBM V₁₅, PBM V₁₅, V₂₀, and PTV. The PBM V₂₀ of ≥Grade 2 neutropenia patients was significantly higher than that of Grade 0-1 neutropenia patients. Multivariate analysis have demonstrated that IBM V₂₀ and LSBM V₁₅ were the independent factors affecting ≥ Grade 2 leukopenia. There is a correlation between low dose-volume parameters with acute bone marrow suppression. IBM V₂₀, LSBM V₁₅ and PBM V₂₀ can be employed as the predictors of acute bone marrow suppression.

Helical tomotherapy combined with capecitabine in the preoperative treatment of locally advanced rectal cancer

The aim of this study was to evaluate the efficacy of helical tomotherapy plus capecitabine as a preoperative chemoradiotherapy (CRT) in patients with locally advanced rectal cancer (LARC). Thirty-six LARC patients receiving preoperative CRT were analyzed. Radiotherapy (RT) consisted of 45 Gy to the regional lymph nodes and simultaneous-integrated boost (SIB) 50.4 Gy to the tumor, 5 days/week for 5 weeks. Chemotherapy consisted of capecitabine 850 mg/m(2), twice daily, during the RT days. Patients underwent surgery 6-8 weeks after completion of CRT. Information was collected for patient characteristics, treatment response, and acute and late toxicities. Grade 3/4 (G3+) toxicities occurred in 11.1% of patients (4/36). Sphincter preservation rate was 85.2% (23/27). Five patients (14.3%) achieved pathological complete response. Tumor, nodal, and ypT0-2N0 downstaging were noted in 60% (21/35), 69.6% (16/23), and 57.1% (20/35). Tumor regression grade 2~4 was achieved in 28 patients (80%). After a median follow-up time of 35 months, the most common G3+ late morbidity was ileus and fistula (5.7%, 2/35). The study showed that capecitabine plus helical tomotherapy with an SIB is feasible in treatment of LARC. The treatment modality can achieve a very encouraging sphincter preservation rate and a favorable ypT0-2N0 downstaging rate without excessive toxicity.

Prognosis factors for recurrence in patients with locally advanced rectal cancer preoperatively treated with chemoradiotherapy and adjuvant chemotherapy

BACKGROUND

Neoadjuvant chemoradiotherapy followed by total mesorectal excision has improved the outcome of locally advanced rectal carcinoma.

OBJECTIVE

The aim of this study was to identify independent prognosis factors of disease recurrence in a group of patients treated with this approach.

DESIGN AND PATIENTS

This study was retrospective in design. Data from patients with locally advanced rectal cancer who had completed treatment from 2000 to 2010 were reviewed.

SETTINGS

The analysis was performed in a tertiary referral center.

MAIN OUTCOME MEASURES

The primary outcomes measured were the recurrence risk factors.

RESULTS

The cohort consisted of 228 patients; 69.3% of them were men, and median age was 59 years. Stage III rectal cancer was found in 64.9% of patients. The most frequently administered therapy was concurrent capecitabine, oxaliplatin, and 7-field radiotherapy, followed by 3-field radiotherapy and fluoropyrimidines. After a median follow-up of 49 months, 23.7% of the patients experienced disease recurrence: 2.6% had local recurrence, 21.1% had distant metastases, and 0.5% had both. Factors significantly correlated with recurrence risk in multivariate logistic regression were y-pathological stage (III vs I/II: OR = 2.51), tumor regression grade (1/2 vs 3+/4: OR = 3.34; 3 vs 3+/4: OR = 1.20), and low rectal location (OR = 2.36). The only independent prognosis factor for liver metastases was tumor regression grade (1/2 vs 3+/4: OR = 4.67; 3 vs 3+/4: OR = 1.41), whereas tumor regression grade (1-2 vs 3+/4: OR = 5.5; 3 vs 3+/4: OR = 1.84), low rectal location (OR = 3.23), and previous liver metastasis (OR = 7.73) predicted lung recurrence.

LIMITATIONS

This is a single institutional experience, neoadjuvant combined therapy is not homogeneous, and the analysis has been performed in a retrospective manner.

CONCLUSIONS

Patients with low third locally advanced rectal cancer with a poor response to neoadjuvant chemoradiotherapy (high y-pathological stage or low tumor regression grade) are at high risk of recurrence. Intense surveillance and the design of alternative therapeutic approaches aimed to lower the distant failure rate seem warranted.