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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 Koo 
 JOURNAL OF RADIATION RESEARCH, Vol.58(4) : 559-566, 2017 
Journal Title
Issue Date
Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; Disease-Free Survival ; Dose-Response Relationship, Radiation ; Humans ; Middle Aged ; Neoplasm Recurrence, Local/surgery ; Organ Sparing Treatments* ; Pelvis/pathology* ; Postoperative Care* ; Prognosis ; Rectal Neoplasms/diagnostic imaging ; Rectal Neoplasms/radiotherapy* ; Rectal Neoplasms/surgery* ; Rectum/diagnostic imaging ; Rectum/pathology ; Rectum/surgery* ; Tomography, X-Ray Computed
anastomosis ; local recurrence ; postoperative ; rectal cancer ; whole-pelvis radiotherapy
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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1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Koom, Woong Sub(금웅섭) ORCID logo https://orcid.org/0000-0002-9435-7750
Kim, Nam Kyu(김남규) ORCID logo https://orcid.org/0000-0003-0639-5632
Kim, Yong Bae(김용배) ORCID logo https://orcid.org/0000-0001-7573-6862
Min, Byung Soh(민병소) ORCID logo https://orcid.org/0000-0003-0180-8565
Shin, Sang Joon(신상준) ORCID logo https://orcid.org/0000-0001-5350-7241
Ahn, Joong Bae(안중배) ORCID logo https://orcid.org/0000-0001-6787-1503
Lim, Joon Seok(임준석) ORCID logo https://orcid.org/0000-0002-0334-5042
Chang, Jee Suk Paul(장지석) ORCID logo https://orcid.org/0000-0001-7685-3382
Hur, Hyuk(허혁) ORCID logo https://orcid.org/0000-0002-9864-7229
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