Oncotarget

Research Papers:

Impact of neoadjuvant and adjuvant radiotherapy on disease-specific survival in patients with stages II–IV rectal cancer

Yinying Wu, Haiyang Liu, Xianglin L. Du, Fan Wang, Jing Zhang, Xiaohai Cui, Enxiao Li, Jin Yang, Min Yi _ and Yunfeng Zhang

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Oncotarget. 2017; 8:106913-106925. https://doi.org/10.18632/oncotarget.22460

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Abstract

Yinying Wu1, Haiyang Liu2, Xianglin L. Du3, Fan Wang1, Jing Zhang4, Xiaohai Cui4, Enxiao Li1, Jin Yang1, Min Yi1,5 and Yunfeng Zhang4

1Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China

2Department of Radiation Imaging, Shangluo Central Hospital, Shangluo, Shaanxi, People’s Republic of China

3Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston, TX, USA

4Second Department of Thoracic Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China

5Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

Correspondence to:

Min Yi, email: [email protected]

Yunfeng Zhang, email: [email protected]

Keywords: radiation therapy; neoadjuvant/adjuvant; disease specific survival; rectal cancer; tumor stage

Received: June 20, 2017     Accepted: October 12, 2017     Published: November 06, 2017

ABSTRACT

Objectives: The purposes of this study were to determine whether neoadjuvant or adjuvant radiotherapy affected disease-specific survival (DSS) in patients with rectal cancer and whether stratification by tumor stage affected the results.

Results: 55.5% patients had neoadjuvant-radiotherapy (NRT), and 18.3% patients had adjuvant- radiotherapy (ART). Multivariable models showed that treatment type was independently associated with DSS. Patients with stages III/IV tumors who received ART plus chemotherapy had significantly worse DSS than did those who received NRT plus chemotherapy (NCRT) (P = 0.03). Among patients with stage II tumors, those who received ART plus chemotherapy and those who received NCRT had similar DSS. Further stratification by risk group revealed that patients with stage IIIA tumors who received ART plus chemotherapy had significantly better DSS than did those who received NCRT (P = 0.04). The ART plus chemotherapy and NCRT groups had similar DSS in patients with stage IIA tumors. Among high-risk patients (T3N+/T4), the NCRT group had significantly better DSS than did the ART plus chemotherapy group. Patients who underwent surgery only had the worst DSS of all the treatment groups.

Materials and Methods: From the Surveillance, Epidemiology, and End Results database, patients diagnosed with stages II–IV rectal cancer from 2004–2014 were identified. Clinicopathologic features, treatments, and DSS in different treatment groups were compared.

Conclusions: NCRT or ART plus chemotherapy can reduce deaths from rectal cancer. Patients with stage IIIA tumors will benefit most from ART plus chemotherapy, whereas NCRT should be recommended to patients with stages II, IIIB, or higher tumors.


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