Upfront chemotherapy and short-course radiotherapy with delayed surgery for locally advanced rectal cancer with synchronous liver metastases |
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| Affiliation: | 1. The Division of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea;2. Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea;3. Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea;1. Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, Hubei Province, 430030, China;2. Department of Anesthesiology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, Hubei Province, 430030, China;1. Department of General Surgery, Monash University Endocrine Surgery Unit, The Alfred Hospital, Melbourne, Australia;2. Department of Surgery, Monash University, Melbourne, Australia;3. Department of Surgery, Monash Health, Melbourne, Australia;1. Dept. of Surgical Oncology, Zydus Hospital, Ahmedabad, India;2. Dept. of Surgical Oncology, Saifee Hospital, Mumbai, India;3. Dept. of Radiology, Centre Hospitalier Lyon-sud, Lyon, France;4. Dept. of Surgical Oncology, Jehangir Hospital, Pune, India;5. Dept. of Pathology, Zydus Hospital, Ahmedabad, India;6. Dept. of Radiology, Zydus Hospital, Ahmedabad, India;7. Dept. of Surgical Oncology, Centre Hospitalier Lyon-sud, Lyon, France;8. India Dept. of Pathology, Centre Hospitalier Lyon-sud, Lyon, France;1. Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy;2. IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy;3. Department of Community and Clinical Sciences, University of Milan, Milan, Italy;1. Department of Gynaecology and Obstetrics, Intercommunal Hospital Centre of Poissy-Saint-Germain-en-Laye, 78300, Poissy, France;2. Department of Gynaecology and Obstetrics, Assistance Publique – Hôpitaux de Paris, Hôpital Européen Georges Pompidou, France;3. Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, Institut Universitaire de Cancérologie (IUC), Paris, France;4. Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Créteil, France;5. Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France;6. Department of Obstetrics and Gynecology, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France;7. Department of Obstetrics and Gynecology, Centre Hospitalier Régional Universitaire, Lille, France;8. Department of Obstetrics and Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, Tours, France;9. Department of Obstetrics and Gynecology, Jean-Verdier University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France;10. CRLCC Eugène-Marquis, Service de Gynécologie, CHU de Rennes, Université de Rennes 1, Rennes, France;11. Department of Obstetrics and Gynecology, Hopital Nord, APHM, Marseille, France;12. EA 7285 Risques Cliniques et Sécurité en Santé des Femmes, University of Versailles-Saint-Quentin en Yvelines, France;13. Department of Obstetrics and Gynecology, Assistance Publique – Hôpitaux de Paris, Hôpital LARIBOISIERE, University of Paris, France;1. Department of Surgery, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA;2. Division of Surgical Oncology, Department of Surgery, Henry Ford Hospital, 2800 West Grand Blvd, Detroit, MI, 48202, USA;3. Department of Public Health Sciences, Henry Ford Health System, One Ford Place, Detroit, MI, 48202, USA |
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| Abstract: | ![]()
BackgroundThe 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.MethodsForty-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.ResultsAt 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.ConclusionUpfront 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. |
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| Keywords: | Locally advanced rectal cancer Upfront chemotherapy Short course radiotherapy Synchronous liver metastasis |
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