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Upfront chemotherapy and short-course radiotherapy with delayed surgery for locally advanced rectal cancer with synchronous liver metastases

Authors
 Hyeon Woo Bae  ;  Ho Seung Kim  ;  Seung Yoon Yang  ;  Han Sang Kim  ;  Sang Joon Shin  ;  Jee Suk Chang  ;  Woong Sub Koom  ;  Nam Kyu Kim 
Citation
 EJSO, Vol.47(11) : 2814-2820, 2021-11 
Journal Title
EJSO
ISSN
 0748-7983 
Issue Date
2021-11
MeSH
Adult ; Aged ; Chemoradiotherapy* ; Combined Modality Therapy ; Female ; Humans ; Liver Neoplasms / pathology ; Liver Neoplasms / surgery ; Liver Neoplasms / therapy* ; Male ; Middle Aged ; Neoplasms, Multiple Primary / pathology ; Postoperative Complications ; Rectal Neoplasms / pathology ; Rectal Neoplasms / surgery ; Rectal Neoplasms / therapy* ; Retrospective Studies
Keywords
Locally advanced rectal cancer ; Short course radiotherapy ; Synchronous liver metastasis ; Upfront chemotherapy
Abstract
Background: The optimal treatment of locally advanced rectal cancer with synchronous liver metastases remains controversial. In this study, we aimed to evaluate the safety, efficacy, and oncologic outcomes of upfront chemotherapy and short-course radiotherapy with delayed surgery in patients with locally advanced rectal cancer and synchronous liver metastases.

Methods: Forty-four patients who underwent upfront chemotherapy and short-course radiotherapy with delayed surgery for locally advanced rectal cancer (cT3/4, <2.0 mm from the mesorectal fascia) with synchronous liver metastases between January 2010 and June 2017 were reviewed retrospectively. Primary and metastatic liver lesions were resected with curative intent. Upfront chemotherapy and short-course radiotherapy were administered. Thereafter, restaging, surgery only, or additional chemotherapy followed by surgery was performed.

Results: At the time of initial diagnosis, 20 patients had <3 liver metastases; 24 patients had ≥3 liver metastases. Twenty-three patients had hemi-liver metastases; 21 patients had bilobar liver metastases. R0 resection of rectal lesions was achieved in 43 patients. Synchronous R0 resection of liver metastases was achieved in 41 patients. Postoperative complications (Clavien-Dindo Grade ≥ III) were noted in 5 patients. Grade 3/4 adverse events were observed in 26 patients. All adverse events were managed effectively with medication and supportive care. The 3-year overall survival and progression-free survival rates were 65.3% and 26.9%, respectively.

Conclusion: Upfront chemotherapy and short-course radiotherapy with delayed surgery appear to be safe and effective in patients with locally advanced rectal cancer and synchronous liver metastases without substantially increasing treatment induced morbidity.
Full Text
https://www.sciencedirect.com/science/article/pii/S0748798321004947?via%3Dihub
DOI
10.1016/j.ejso.2021.05.018
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
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
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, Han Sang(김한상) ORCID logo https://orcid.org/0000-0002-6504-9927
Kim, Ho Seung(김호승)
Shin, Sang Joon(신상준) ORCID logo https://orcid.org/0000-0001-5350-7241
Yang, Seung Yoon(양승윤) ORCID logo https://orcid.org/0000-0001-8129-7712
Chang, Jee Suk(장지석) ORCID logo https://orcid.org/0000-0001-7685-3382
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/187557
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