Systemic chemotherapy and short-course radiation in metastatic rectal cancers: A feasible paradigm in unresectable and potentially resectable cancers.
Chemotherapy
metastatectomy
metastatic rectal cancers
resectability
short-course radiotherapy
Journal
South Asian journal of cancer
ISSN: 2278-330X
Titre abrégé: South Asian J Cancer
Pays: India
ID NLM: 101618774
Informations de publication
Date de publication:
Historique:
entrez:
10
5
2019
pubmed:
10
5
2019
medline:
10
5
2019
Statut:
ppublish
Résumé
The optimal use and sequencing of short-course radiotherapy (SCRT) in metastatic rectal cancers (mRCs) are not well established. We retrospectively reviewed the records of mRC patients receiving SCRT followed by palliative chemotherapy between January 1, 2013, and December 31, 2016, in Tata Memorial Hospital. Patients were classified as having "potentially resectable" disease (local and metastatic) or "unresectable" disease at baseline based on prespecified criteria. A total of 105 consecutive patients were available for analysis. The median age of patients was 48 years (range: 16-62 years), and 57.1% were male patients. Signet ring histology was seen in 13.3% of patients. The most common site of metastases was liver limited (29.5%), nonloco-regional nodes (12.4%), and lung limited metastases (9.5%). Chemotherapeutic regimens administered were capecitabine-oxaliplatin (70.5%), modified 5 fluorouracil (5 FU)-leucovorin-irinotecan-oxaliplatin (10.5%), and modified 5 FU-leucovorin-irinotecan (8.6%). Targeted therapy accompanying chemotherapy was administered in 27.6% of patients. About 42.1% of patients with potentially resectable disease and 11.1% with the unresectable disease at baseline underwent curative-intent resection of the primary and address of metastatic sites. With a median follow-up 18.2 months, median overall survival (OS) was 15.7 months (95% confidence interval: 10.42-20.99). Patients classified as potentially resectable had a median OS of 32.62 months while patients initially classified as unresectable had a median OS of 13.04 months ( SCRT followed by systemic therapy in mRC is a feasible, efficacious paradigm for maximizing palliation, and achieving objective responses. The classification of patients based on resectability was predictive of actual resection rates as well as outcomes. Signet ring mRC show inferior outcomes in this cohort of patients.
Sections du résumé
BACKGROUND
BACKGROUND
The optimal use and sequencing of short-course radiotherapy (SCRT) in metastatic rectal cancers (mRCs) are not well established.
MATERIALS AND METHODS
METHODS
We retrospectively reviewed the records of mRC patients receiving SCRT followed by palliative chemotherapy between January 1, 2013, and December 31, 2016, in Tata Memorial Hospital. Patients were classified as having "potentially resectable" disease (local and metastatic) or "unresectable" disease at baseline based on prespecified criteria.
RESULTS
RESULTS
A total of 105 consecutive patients were available for analysis. The median age of patients was 48 years (range: 16-62 years), and 57.1% were male patients. Signet ring histology was seen in 13.3% of patients. The most common site of metastases was liver limited (29.5%), nonloco-regional nodes (12.4%), and lung limited metastases (9.5%). Chemotherapeutic regimens administered were capecitabine-oxaliplatin (70.5%), modified 5 fluorouracil (5 FU)-leucovorin-irinotecan-oxaliplatin (10.5%), and modified 5 FU-leucovorin-irinotecan (8.6%). Targeted therapy accompanying chemotherapy was administered in 27.6% of patients. About 42.1% of patients with potentially resectable disease and 11.1% with the unresectable disease at baseline underwent curative-intent resection of the primary and address of metastatic sites. With a median follow-up 18.2 months, median overall survival (OS) was 15.7 months (95% confidence interval: 10.42-20.99). Patients classified as potentially resectable had a median OS of 32.62 months while patients initially classified as unresectable had a median OS of 13.04 months (
CONCLUSIONS
CONCLUSIONS
SCRT followed by systemic therapy in mRC is a feasible, efficacious paradigm for maximizing palliation, and achieving objective responses. The classification of patients based on resectability was predictive of actual resection rates as well as outcomes. Signet ring mRC show inferior outcomes in this cohort of patients.
Identifiants
pubmed: 31069186
doi: 10.4103/sajc.sajc_174_18
pii: SAJC-8-92
pmc: PMC6498721
doi:
Types de publication
Journal Article
Langues
eng
Pagination
92-97Déclaration de conflit d'intérêts
There are no conflicts of interest.
Références
J Clin Oncol. 2005 Aug 1;23(22):4866-75
pubmed: 15939922
J Clin Oncol. 2005 Aug 20;23(24):5644-50
pubmed: 16110023
Clin Colorectal Cancer. 2005 Nov;5(4):263-7
pubmed: 16356303
Br J Surg. 2006 Oct;93(10):1215-23
pubmed: 16983741
Lancet. 2008 Mar 22;371(9617):1007-16
pubmed: 18358928
J Clin Oncol. 2008 Apr 10;26(11):1830-5
pubmed: 18398148
Eur J Cancer. 2009 Jan;45(2):228-47
pubmed: 19097774
N Engl J Med. 2009 Apr 2;360(14):1408-17
pubmed: 19339720
Colorectal Dis. 2010 Oct;12(10 Online):e182-9
pubmed: 20128837
Int J Colorectal Dis. 2010 Oct;25(10):1221-9
pubmed: 20686777
Br J Cancer. 2010 Nov 9;103(10):1542-7
pubmed: 20959822
Br J Cancer. 2011 Jun 28;105(1):58-64
pubmed: 21673685
Ann Surg Oncol. 2011 Nov;18(12):3252-60
pubmed: 21822557
Ann Surg Oncol. 2012 Apr;19(4):1292-301
pubmed: 21922338
Eur J Cancer. 2011 Sep;47 Suppl 3:S61-6
pubmed: 21944031
Indian J Cancer. 2011 Oct-Dec;48(4):391-6
pubmed: 22293249
Ann Surg Oncol. 2012 Sep;19(9):2814-21
pubmed: 22476818
Oncologist. 2012;17(10):1225-39
pubmed: 22962059
AJR Am J Roentgenol. 2012 Oct;199(4):W486-95
pubmed: 22997398
Ann Oncol. 2013 Jul;24(7):1762-9
pubmed: 23524865
Int J Hepatol. 2013;2013:815105
pubmed: 23970972
Ann Oncol. 2013 Nov;24(11):2829-34
pubmed: 24013512
Ann Oncol. 2014 May;25(5):1018-25
pubmed: 24585720
J Clin Oncol. 2014 Jul 20;32(21):2240-7
pubmed: 24687833
West Indian Med J. 2013 Jul;62(6):504-9
pubmed: 24756735
Lancet Oncol. 2014 Sep;15(10):1065-75
pubmed: 25088940
Clin Colorectal Cancer. 2015 Mar;14(1):52-7
pubmed: 25442812
Ann Oncol. 2015 Apr;26(4):702-8
pubmed: 25538173
PLoS One. 2015 Mar 19;10(3):e0121944
pubmed: 25789685
Indian J Radiol Imaging. 2015 Apr-Jun;25(2):148-61
pubmed: 25969638
JAMA Oncol. 2015 Sep;1(6):778-84
pubmed: 26203912
BMC Cancer. 2015 Oct 23;15:764
pubmed: 26493588
Ann Oncol. 2016 May;27(5):834-42
pubmed: 26884592
J Gastrointest Oncol. 2016 Jun;7(3):380-6
pubmed: 27284470
Ann Oncol. 2016 Aug;27(8):1386-422
pubmed: 27380959
PLoS One. 2016 Aug 18;11(8):e0161475
pubmed: 27536871
BMC Cancer. 2016 Aug 24;16:677
pubmed: 27558497
Drugs Real World Outcomes. 2016 Mar;3(1):69-82
pubmed: 27747803
J Gastrointest Oncol. 2016 Dec;7(6):958-967
pubmed: 28078119
JAMA. 2017 Jun 20;317(23):2392-2401
pubmed: 28632865
Anticancer Res. 2017 Jul;37(7):3817-3823
pubmed: 28668881
Ann Oncol. 2017 Jul 1;28(suppl_4):iv22-iv40
pubmed: 28881920