Role of Preoperative Chemoradiotherapy in Clinical Stage II/III Rectal Cancer Patients Undergoing Total Mesorectal Excision: A Retrospective Propensity Score Analysis

Jii Bum Lee, Han Sang Kim, Ahrong Ham, Jee Suk Chang, Sang Jun Shin, Seung Hoon Beom, Woong Sub Koom, Taeil Kim, Yoon Dae Han, Dai Hoon Han, Hyuk Hur, Byung Soh Min, Kang Young Lee, Nam Kyu Kim, Yu Rang Park, Joon Seok Lim, Joong Bae Ahn

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Background: Although the current standard preoperative chemoradiotherapy (PCRT) for stage II/III rectal cancer decreases the risk of local recurrence, it does not improve survival and increases the likelihood of preoperative overtreatment, especially in patients without circumferential resection margin (CRM) involvement. Methods: Stage II/III rectal cancer without CRM involvement and lateral lymph node metastasis was radiologically defined by preoperative magnetic resonance imaging (MRI). Patients who received PCRT followed by total mesorectal excision (TME) (PCRT group) and upfront surgery (US) with TME (US group) between 2010 and 2016 were analyzed. We derived cohorts of PCRT group versus US group using propensity-score matching for stage, age, and distance from the anal verge. Three-year relapse-free survival rate, disease-free survival (DFS), and overall survival (OS) were compared between the two groups. Results: A total of 202 patients were analyzed after propensity score matching. There were no differences in baseline characteristics. The median follow-up duration was 62 months (interquartile range, 46–87). There was no difference in the 3-year disease-free survival rate between the PCRT and US groups (83 vs. 88%, respectively; p=0.326). Likewise, there was no significant difference in the 3-year OS (89 vs. 91%, respectively; p=0.466). The 3-year locoregional recurrence rates (3 vs. 2% with US, p=0.667) and distant metastasis rates (16 vs. 11%, p=0.428) were not significantly different between the two groups. Time to completion of curative treatment was significantly shorter in the US group (132 days) than in the PCRT group (225 days) (p<0.001). Conclusion: Using MRI-guided selection for better risk stratification, US without neoadjuvant therapy can be considered in early stage patients with good prognosis. PCRT may not be required for all stage II/III rectal cancer patients, especially for the MRI-proven intermediate-risk group (cT1-2/N1, cT3N0) without CRM involvement and lateral lymph node metastasis. Further prospective studies are warranted.

Original languageEnglish
Article number609313
JournalFrontiers in Oncology
Publication statusPublished - 2021 Jan 18

Bibliographical note

Funding Information:
The content of this manuscript has been presented in part at the European Society for Medical Oncology (ESMO) in 2019? (36).

Publisher Copyright:
© Copyright © 2021 Lee, Kim, Ham, Chang, Shin, Beom, Koom, Kim, Han, Han, Hur, Min, Lee, Kim, Park, Lim and Ahn.

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research


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