Reduced pelvic field sparing anastomosis for postoperative radiotherapy in selected patients with mid-upper rectal cancer

Seo Hee Choi, Jee Suk Chang, Nam Kyu Kim, Joon Seok Lim, Byung So Min, Hyuk Hur, Sang Joon Shin, Joong Bae Ahn, Yong Bae Kim, Woong Sub Koom

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Abstract

The aim of this study was to report the clinical results of reduced pelvic field radiotherapy (RT), excluding the anastomotic site, after total mesorectal excision in selected patients with rectal cancer. Between 2011 and 2014, 99 patients underwent upfront surgery for clinically less-advanced tumors but were finally diagnosed as pT3/N+. Among them, 50 patients with mid-upper rectal cancer who received postoperative RT with a reduced pelvic field were included in this retrospective review. This group was composed of patients with high seated tumors, complete resection with a clear circumferential resection margin, and no complication during surgery. We investigated treatment outcomes, toxicity and the effect of RT-field reduction on organs-at risk in 5 randomly selected patients. During the median follow-up period of 42 months (range: 15-59 months), tumors recurred in 9 patients (18%). The 3-year overall and disease-free survival were 98% and 81%, respectively. Distant metastasis was the dominant failure pattern (n = 8, 16%), while no recurrences occurred at or near anastomotic sites. No anastomotic complications were found on pelvic examination, images and/or colonoscopy. Reported acute and late RT-related toxicities were mostly mild to moderate, with only small numbers of Grade 3 toxicities. None of the patients developed Grade 4-5 acute or late toxicity. With a caudally reduced field, 64% reduction in absolute anastomotic exposure at the maximum dose was achieved compared with the traditional whole-pelvic field (P = 0.008). The reduced pelvic field RT was able to minimize late anastomotic complication without increasing its recurrence in selected patients with mid-upper rectal cancer in the postoperative setting.

Original languageEnglish
Pages (from-to)559-566
Number of pages8
JournalJournal of radiation research
Volume58
Issue number4
DOIs
Publication statusPublished - 2017 Jul 1

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Rectal Neoplasms
radiation therapy
Radiotherapy
cancer
toxicity
tumors
surgery
grade
Organs at Risk
Recurrence
Neoplasms
Gynecological Examination
metastasis
Colonoscopy
organs
Disease-Free Survival
margins
examination
Neoplasm Metastasis
dosage

All Science Journal Classification (ASJC) codes

  • Radiation
  • Radiology Nuclear Medicine and imaging
  • Health, Toxicology and Mutagenesis

Cite this

Choi, Seo Hee ; Chang, Jee Suk ; Kim, Nam Kyu ; Lim, Joon Seok ; Min, Byung So ; Hur, Hyuk ; Shin, Sang Joon ; Ahn, Joong Bae ; Kim, Yong Bae ; Koom, Woong Sub. / Reduced pelvic field sparing anastomosis for postoperative radiotherapy in selected patients with mid-upper rectal cancer. In: Journal of radiation research. 2017 ; Vol. 58, No. 4. pp. 559-566.
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abstract = "The aim of this study was to report the clinical results of reduced pelvic field radiotherapy (RT), excluding the anastomotic site, after total mesorectal excision in selected patients with rectal cancer. Between 2011 and 2014, 99 patients underwent upfront surgery for clinically less-advanced tumors but were finally diagnosed as pT3/N+. Among them, 50 patients with mid-upper rectal cancer who received postoperative RT with a reduced pelvic field were included in this retrospective review. This group was composed of patients with high seated tumors, complete resection with a clear circumferential resection margin, and no complication during surgery. We investigated treatment outcomes, toxicity and the effect of RT-field reduction on organs-at risk in 5 randomly selected patients. During the median follow-up period of 42 months (range: 15-59 months), tumors recurred in 9 patients (18{\%}). The 3-year overall and disease-free survival were 98{\%} and 81{\%}, respectively. Distant metastasis was the dominant failure pattern (n = 8, 16{\%}), while no recurrences occurred at or near anastomotic sites. No anastomotic complications were found on pelvic examination, images and/or colonoscopy. Reported acute and late RT-related toxicities were mostly mild to moderate, with only small numbers of Grade 3 toxicities. None of the patients developed Grade 4-5 acute or late toxicity. With a caudally reduced field, 64{\%} reduction in absolute anastomotic exposure at the maximum dose was achieved compared with the traditional whole-pelvic field (P = 0.008). The reduced pelvic field RT was able to minimize late anastomotic complication without increasing its recurrence in selected patients with mid-upper rectal cancer in the postoperative setting.",
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Reduced pelvic field sparing anastomosis for postoperative radiotherapy in selected patients with mid-upper rectal cancer. / Choi, Seo Hee; Chang, Jee Suk; Kim, Nam Kyu; Lim, Joon Seok; Min, Byung So; Hur, Hyuk; Shin, Sang Joon; Ahn, Joong Bae; Kim, Yong Bae; Koom, Woong Sub.

In: Journal of radiation research, Vol. 58, No. 4, 01.07.2017, p. 559-566.

Research output: Contribution to journalArticle

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AU - Choi, Seo Hee

AU - Chang, Jee Suk

AU - Kim, Nam Kyu

AU - Lim, Joon Seok

AU - Min, Byung So

AU - Hur, Hyuk

AU - Shin, Sang Joon

AU - Ahn, Joong Bae

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AU - Koom, Woong Sub

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AB - The aim of this study was to report the clinical results of reduced pelvic field radiotherapy (RT), excluding the anastomotic site, after total mesorectal excision in selected patients with rectal cancer. Between 2011 and 2014, 99 patients underwent upfront surgery for clinically less-advanced tumors but were finally diagnosed as pT3/N+. Among them, 50 patients with mid-upper rectal cancer who received postoperative RT with a reduced pelvic field were included in this retrospective review. This group was composed of patients with high seated tumors, complete resection with a clear circumferential resection margin, and no complication during surgery. We investigated treatment outcomes, toxicity and the effect of RT-field reduction on organs-at risk in 5 randomly selected patients. During the median follow-up period of 42 months (range: 15-59 months), tumors recurred in 9 patients (18%). The 3-year overall and disease-free survival were 98% and 81%, respectively. Distant metastasis was the dominant failure pattern (n = 8, 16%), while no recurrences occurred at or near anastomotic sites. No anastomotic complications were found on pelvic examination, images and/or colonoscopy. Reported acute and late RT-related toxicities were mostly mild to moderate, with only small numbers of Grade 3 toxicities. None of the patients developed Grade 4-5 acute or late toxicity. With a caudally reduced field, 64% reduction in absolute anastomotic exposure at the maximum dose was achieved compared with the traditional whole-pelvic field (P = 0.008). The reduced pelvic field RT was able to minimize late anastomotic complication without increasing its recurrence in selected patients with mid-upper rectal cancer in the postoperative setting.

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