Effect of preoperative treatment strategies on the outcome of patients with clinical T3, non-metastasized rectal cancer: A comparison between Dutch and Canadian expert centers. Issue 8 (August 2015)

• Record Type: Journal Article
• Authors: Breugom, A.J.; Vermeer, T.A.; van den Broek, C.B.M.; Vuong, T.; Bastiaannet, E.; Azoulay, L.; Dekkers, O.M.; Niazi, T.; van den Berg, H.A.; Rutten, H.J.T.; van de Velde, C.J.H.
• Is Part Of: European journal of surgical oncology. Volume 41:Issue 8(2015:Aug.)
• Page Start: 1039
• Page End: 1044
• Publication Date: 2015-08
• Subjects: Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2015.05.002
• Languages: English
• ISSNs: 0748-7983

Abstract

<abstract xml:lang="en" abstract-type="author" id="abs0010"> <title id="sectitle0010">Abstract</title> <sec> <title id="sectitle0015">Aim</title> <p id="abspara0010">High-dose-rate brachytherapy (HDRBT) appears to be associated with less treatment-related toxicity compared with external beam radiotherapy in patients with rectal cancer. The present study compared the effect of preoperative treatment strategies on overall survival, cancer-specific deaths, and local recurrences between a Dutch and Canadian expert center with different preoperative treatment strategies.</p> </sec> <sec> <title id="sectitle0020">Patients and methods</title> <p id="abspara0015">We included 145 Dutch and 141 Canadian patients with cT3, non-metastasized rectal cancer. All patients from Canada were preoperatively treated with HDRBT. The preoperative treatment strategy for Dutch patients consisted of either no preoperative treatment, short-course radiotherapy, or chemoradiotherapy.</p> <p id="abspara0020">Cox proportional hazards models were used to estimate hazard ratios (HR) with 95% confidence intervals (CIs) comparing overall survival. We adjusted for age, cN stage, (y)pT stage, comorbidity, and type of surgery. Primary endpoint was overall survival. Secondary endpoints were cancer-specific deaths and local recurrences.</p> </sec> <sec> <title id="sectitle0025">Results</title> <p id="abspara0025">Five-year overall survival was 70.9% (95% CI 62.6%–77.7%) in Dutch patients compared with 86.9% (80.1%–91.6%) in Canadian patients, resulting in an adjusted HR of 0.70 (95% CI 0.39–1.26; p = 0.233). Of 145 Dutch patients, 6.9% (95% CI 2.8%–11.0%) had a local recurrence and 17.9% (95% CI 11.7%–24.2%) patients died of rectal cancer, compared with 4.3% (95% CI 0.9%–7.5%) local recurrences and 10.6% (95% CI 5.5%–15.7%) rectal cancer deaths out of 141 Canadian patients.</p> </sec> <sec> <title id="sectitle0030">Conclusion</title> <p id="abspara0030">We did not detect statistically significant differences in overall survival between a Dutch and Canadian expert center with different treatment strategies. This finding needs to be further investigated in a randomized controlled trial.</p> </sec> </abstract>