Time to surgery and pathologic complete response after neoadjuvant chemoradiation in rectal cancer: A population study on 2094 patients

• Published in: Clinical and translational radiation oncology Vol. 4; no. C; pp. 8 - 14
• Main Authors: Macchia, Gabriella, Gambacorta, Maria Antonietta, Masciocchi, Carlotta, Chiloiro, Giuditta, Mantello, Giovanna, di Benedetto, Maika, Lupattelli, Marco, Palazzari, Elisa, Belgioia, Liliana, Bacigalupo, Almalina, Sainato, Aldo, Montrone, Sabrina, Turri, Lucia, Caroli, Angela, De Paoli, Antonino, Matrone, Fabio, Capirci, Carlo, Montesi, Giampaolo, Niespolo, Rita Marina, Osti, Mattia Falchetto, Caravatta, Luciana, Galardi, Alessandra, Genovesi, Domenico, Rosetto, Maria Elena, Boso, Caterina, Sciacero, Piera, Giaccherini, Lucia, Parisi, Salvatore, Fontana, Antonella, Filippone, Francesco Romeo, Picardi, Vincenzo, Morganti, Alessio Giuseppe, Valentini, Vincenzo
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.06.2017; Elsevier
• Subjects: Chemoradiation; Rectal cancer; Surgery; Time interval; TME; Time interval; Rectal cancer; TME; Surgery; Chemoradiation
• ISSN: 2405-6308; 2405-6308
• DOI: 10.1016/j.ctro.2017.04.004

•A large population based analysis to evaluate pathologic response according to time of surgery.•LARC patients were treated with modern techniques of radiotherapy and surgery.•The rate of pCR increased according to time interval from 12.6% to 31.1%.•The pCR increasing was 1.5% (about 0.2%/die) per each week of waiting.•Lengthening the interval (>13weeks) significantly improved the pathological response. To retrospectively evaluate the difference in terms of pathologic complete response (pCR) according to time elapsed between chemoradiation (CRT) and total mesorectal excision (TME) on a large unselected real-life dataset of locally advanced rectal cancer (LARC) patients. A multicentre retrospective cohort study of LARC patients from 21 Italian Radiotherapy Institutions was performed. Patients were stratified into 3 different time intervals from CRT. The 1st group included 300 patients who underwent TME within 6weeks, the 2nd 1598 patients (TME within 7–12weeks) and the 3rd 196 patients (TME within 13 or more weeks after CRT), respectively. Data on 2094 LARC patients treated between 1997 and 2016 were considered suitable for analysis. Overall, 578 patients had stage II while 1516 had stage III histological proven invasive rectal adenocarcinoma. A CRT schedule of one agent (N=1585) or 2-drugs (N=509) was administered. Overall, pCR was 22.3% (N=468 patients). The proportion of patients achieving pCR with respect to time interval was, as follows: 12.6% (1st group), 23% (2nd group) and 31.1% (3rd group) (p<0.001), respectively. The pCR relative risk comparison of 2nd to 1st group was 1.8, while 3rd to 2nd group was 1.3. Moreover, between the 3rd and 1st group, a pCR relative risk of 2.4 (p<0.01) was noted. At univariate analysis, clinical stage III (p<0.001), radiotherapy dose >5040cGy (p=0.002) and longer interval (p<0.001) were significantly correlated to pCR. The positive impact of interval (p<0.001) was confirmed at multivariate analysis as the only correlated factor. We confirmed on a population-level that lengthening the interval (>13weeks) from CRT to surgery improves the pathological response (pCR and pathologic partial response; pPR) in comparison to historic data. Furthermore, radiotherapy dose >5040cGy and two drugs chemotherapy correlated with pPR rate.