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Interval to surgery after neoadjuvant treatment for colorectal cancer.

ABSTRACT: The current standard treatment of low-lying locally advanced rectal cancer consists of chemoradiation followed by radical surgery. The interval between chemoradiation and surgery varied for many years until the 1999 Lyon R90-01 trial which compared the effects of a short (2-wk) and long (6-wk) interval. Results showed a better clinical tumor response (71.7% vs 53.1%) and higher rate of positive and pathologic tumor regression (26% vs 10.3%) after the longer interval. Accordingly, a 6-wk interval between chemoradiation and surgery was set to balance the oncological results with the surgical complexity. However, several recent retrospective studies reported that prolonging the interval beyond 8 or even 12 wk may lead to significantly higher rates of tumor downstaging and pathologic complete response. This in turn, according to some reports, may improve overall and disease-free survival, without increasing the surgical difficulty or complications. This work reviews the data on the effect of different intervals, derived mostly from retrospective analyses using a wide variation of treatment protocols. Prospective randomized trials are currently ongoing.

SUBMITTER: Wasserberg N

PROVIDER: S-EPMC3989961 | biostudies-other | 2014 Apr

REPOSITORIES: biostudies-other

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Interval to surgery after neoadjuvant treatment for colorectal cancer.

Wasserberg Nir N

World journal of gastroenterology 20140401 15

The current standard treatment of low-lying locally advanced rectal cancer consists of chemoradiation followed by radical surgery. The interval between chemoradiation and surgery varied for many years until the 1999 Lyon R90-01 trial which compared the effects of a short (2-wk) and long (6-wk) interval. Results showed a better clinical tumor response (71.7% vs 53.1%) and higher rate of positive and pathologic tumor regression (26% vs 10.3%) after the longer interval. Accordingly, a 6-wk interval ...[more]

PMID: 24764663

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Project description:Background: The addition of intensive preoperative chemotherapy and using of a longer waiting period between neoadjuvant radiotherapy and total mesorectal excision (TME) surgery lengthen the time interval from the initiation of neoadjuvant treatment to definitive surgery in patients with locally advanced rectal cancer (LARC). Here, we evaluated the prognostic value of different time intervals between the initiation of neoadjuvant treatment to TME surgery for LARC. Methods: A total of 2,267 patients with LARC, who received neoadjuvant radiochemotherapy and TME surgery, between January 2010 through December 2018 were recruited. The entire cohort was divided into 4 subgroups based on total-time-to surgery, defined as the time interval between initiation of neoadjuvant treatment and TME surgery (TTS): <13 weeks (TTS-1), 13 to <15 weeks (TTS-2), 15 to <17 weeks (TTS-3), ≥17 weeks (TTS-4). Overall survival (OS), disease-free survival (DFS), distant metastasis-free survival (DMFS), and local recurrence-free survival (LRFS) rates in different TTS subgroup patients were compared, and hazard ratios (HR) for different demographic and clinicopathological variables, including TTS, were calculated to determine their prognostic significance. Results: The median follow-up time was 42.0 (range, 5-162) months. The 3-year OS, DFS, DMFS, and LRFS rates were 87.0, 79.4, 80.9, and 93.8%, respectively. The varied OS, DFS, and DFMS rates were detected among these different TTS subgroups (P = 0.010, P < 0.001, and P < 0.001, respectively). Particularly, the lower survival outcome was mainly observed at patients in the shortest TTS group (TTS-1). Cox regression analysis confirmed that the only significant positive independent prognostic factor for 3-year DFS was a longer TTS (TTS 2-4 vs. TTS-1; HR 0.884, 95% CI 0.778-0.921, P < 0.001), while the significant negative independent prognosticfactors were moderate to poor tumor differentiation (vs. well-differentiated; HR 1.191, 95% CI 1.004-1.414, P = 0.045) and clinical N1-2 stage (vs. N0 stage; HR 1.190, 95% CI 1.052-1.347, P = 0.006). Conclusion: For patients with LARC, an interval between the initiation of neoadjuvant treatment and TME surgery of longer than 13 weeks is associated with favorable disease-free survival.

Project description:ImportanceHyperthermic intraperitoneal chemotherapy (HIPEC) followed by interval cytoreductive surgery (ICS) has shown survival benefits for patients with advanced-stage ovarian cancer. However, there is still a lack of consensus regarding the integration of HIPEC into clinical practice.ObjectiveTo evaluate the safety and effectiveness of ICS with HIPEC compared with ICS alone in clinical practice for patients with advanced-stage ovarian cancer.Design, setting, and participantsThis prospective, multicenter, comparative effectiveness cohort study enrolled 205 patients with stage III or IV ovarian cancer who had received at least 3 cycles of neoadjuvant chemotherapy followed by ICS with HIPEC or ICS without HIPEC at 7 Korean Gynecologic Oncology Group institutions between September 1, 2017, and April 22, 2022. Nine patients were excluded because they did not meet the inclusion criteria.ExposuresNeoadjuvant chemotherapy followed by ICS with HIPEC or ICS without HIPEC.Main outcomes and measuresThe primary end point was progression-free survival (PFS). Overall survival (OS) and the safety profile were the key secondary end points.ResultsThis study included 196 patients (median age, 58.0 years [range, 38-82 years]), of whom 109 underwent ICS with HIPEC and 87 underwent ICS without HIPEC. The median duration of follow-up was 28.2 months (range, 3.5-58.6 months). Disease recurrence occurred in 128 patients (65.3%), and 30 patients (15.3%) died. Interval cytoreductive surgery with HIPEC was associated with a significant improvement in median PFS compared with ICS without HIPEC (22.9 months [95% CI, 3.5-58.6 months] vs 14.2 months [95% CI, 4.0-56.2 months]; P = .005) and median OS (not reached [95% CI, 3.5 months to not reached] vs 53.0 [95% CI, 4.6-56.2 months]; P = .002). The frequency of grade 3 or 4 postoperative complications was similar in both groups (ICS with HIPEC, 3 of 109 [2.8%] vs ICS without HIPEC, 3 of 87 [3.4%]; P > .99). Among patients with recurrence, the frequency of peritoneal recurrence was lower in the ICS with HIPEC group than in the ICS without HIPEC group (21 of 64 [32.8%] vs 41 of 64 [64.1%]; P = .001).Conclusions and relevanceThis study suggests that ICS in conjunction with HIPEC was associated with longer PFS and OS than ICS without HIPEC for patients with advanced-stage ovarian cancer and was not associated with higher rates of postoperative complications. The lower rate of peritoneal recurrence after HIPEC may be associated with improved OS.

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Interval to surgery after neoadjuvant treatment for colorectal cancer.

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Interval to surgery after neoadjuvant treatment for colorectal cancer.

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