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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 
 FRONTIERS IN ONCOLOGY, Vol.10 : 609313, 2021-01 
Journal Title
Issue Date
chemoradiotherapy ; rectal cancer ; stage II/III ; total mesorectal excision ; upfront surgery
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.
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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 Biomedical Systems Informatics (의생명시스템정보학교실) > 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, Tae Il(김태일) ORCID logo https://orcid.org/0000-0003-4807-890X
Kim, Han Sang(김한상) ORCID logo https://orcid.org/0000-0002-6504-9927
Min, Byung Soh(민병소) ORCID logo https://orcid.org/0000-0003-0180-8565
Park, Yu Rang(박유랑) ORCID logo https://orcid.org/0000-0002-4210-2094
Beom, Seung Hoon(범승훈) ORCID logo https://orcid.org/0000-0001-7036-3753
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
Lee, Kang Young(이강영)
Lee, Jii Bum(이기쁨) ORCID logo https://orcid.org/0000-0001-5608-3157
Lim, Joon Seok(임준석) ORCID logo https://orcid.org/0000-0002-0334-5042
Chang, Jee Suk(장지석) ORCID logo https://orcid.org/0000-0001-7685-3382
Han, Dai Hoon(한대훈) ORCID logo https://orcid.org/0000-0003-2787-7876
Han, Yoon Dae(한윤대) ORCID logo https://orcid.org/0000-0002-2136-3578
Hur, Hyuk(허혁) ORCID logo https://orcid.org/0000-0002-9864-7229
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