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Original article

Vol. 151 No. 4950 (2021)

Local treatment in the setting of de novo metastatic rectal cancer: reappraisal of prognostic factors

  • Nicolas Vial
  • Julien Langrand-Escure
  • Peng Diao
  • Max-Adrien Garcia
  • Omar Jmour
  • Majed Ben Mrad
  • Jean-Baptiste Guy
  • Wiem Abid
  • Sandrine Sotton
  • Sophie Espenel
  • Elodie Guillaume
  • Amel Rehailia-Blanchard
  • Grégoire Pigné
  • Jane-Chloe Trone
  • Chloe Rancoule
  • David Kaczmarek
  • Thierry Muron
  • Bertrand Le Roy
  • Jean-Marc Phelip
  • Alexis Vallard
  • Nicolas Magné
DOI
https://doi.org/10.4414/SMW.2021.w30034
Cite this as:
Swiss Med Wkly. 2021;151:w30034
Published
15.12.2021

Summary

BACKGROUND: This retrospective study was conducted to: (1) provide more modern data on real-life local management of metastatic rectal cancer; (2) compare therapeutic strategies; and (3) identify prognostic factors of local failure, overall survival and progression-free survival.

METHODS: Data about efficacy and acute toxicity were collected. Patients were diagnosed with metastatic rectal cancer between 2004 and 2015, and were treated at least with radiotherapy. Local failure, overall survival and progression-free survival were correlated with patient, tumour and treatment characteristics using univariate and multivariate analyses.

RESULTS: Data of 148 consecutive patients with metastatic rectal cancer were analysed. Median follow-up was 19 months. Median overall survival was 16 months. All patients received local radiotherapy, with a median equivalent 2 Gy per fraction dose of 47.7 Gy. Rectal surgery was performed in 97 patients (65.6%). The majority of patients (86/97, 88.7%) received pre-operative chemoradiation. In multivariate analysis, rectal surgery was found to be the only independent predictor of increased overall survival (24.6 vs 7.1 months, p <0.001). Of the patients undergoing surgical treatment, 22.8% presented with significant complications that required a delay of systemic treatment. Grade 3–4 acute radiation therapy-related toxicities were observed in 6.1% of patients, mainly gastrointestinal toxicities (5.4%).

CONCLUSION: Rectal surgery was a key predictive factor of increased progression-free survival and overall survival in patients receiving at least local radiotherapy. In our series of real-life patients, local surgery and radiation seemed as well tolerated as reported in selected phase III non-metastatic rectal cancer patients. These data suggested that local management could be beneficial for metastatic rectal cancer patients.

References

  1. Verberne CJ, de Bock GH, Pijl ME, Baas PC, Siesling S, Wiggers T. Palliative resection of the primary tumour in stage IV rectal cancer. Colorectal Dis. 2012 Mar;14(3):314–9. https://doi.org/10.1111/j.1463-1318.2011.02618.x
  2. Bajwa A, Blunt N, Vyas S, Suliman I, Bridgewater J, Hochhauser D, et al. Primary tumour resection and survival in the palliative management of metastatic colorectal cancer. Eur J Surg Oncol. 2009 Feb;35(2):164–7. https://doi.org/10.1016/j.ejso.2008.06.005
  3. Benoist S, Pautrat K, Mitry E, Rougier P, Penna C, Nordlinger B. Treatment strategy for patients with colorectal cancer and synchronous irresectable liver metastases. Br J Surg. 2005 Sep;92(9):1155–60. https://doi.org/10.1002/bjs.5060
  4. Ruo L, Gougoutas C, Paty PB, Guillem JG, Cohen AM, Wong WD. Elective bowel resection for incurable stage IV colorectal cancer: prognostic variables for asymptomatic patients. J Am Coll Surg. 2003 May;196(5):722–8. https://doi.org/10.1016/S1072-7515(03)00136-4
  5. Scoggins CR, Meszoely IM, Blanke CD, Beauchamp RD, Leach SD. Nonoperative management of primary colorectal cancer in patients with stage IV disease. Ann Surg Oncol. 1999 Oct-Nov;6(7):651–7. https://doi.org/10.1007/s10434-999-0651-x
  6. Cotte E, Villeneuve L, Passot G, Boschetti G, Bin-Dorel S, Francois Y, et al. French Research Group of Rectal Cancer Surgery (GRECCAR). GRECCAR 8: impact on survival of the primary tumour resection in rectal cancer with unresectable synchronous metastasis: a randomized multicentre study. BMC Cancer. 2015;15:47. https://doi.org/10.1186/s12885-015-1060-0
  7. Gérard JP, Conroy T, Bonnetain F, Bouché O, Chapet O, Closon-Dejardin MT, et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol. 2006 Oct;24(28):4620–5. https://doi.org/10.1200/JCO.2006.06.7629
  8. Bosset JF, Collette L, Calais G, Mineur L, Maingon P, Radosevic-Jelic L, et al.; EORTC Radiotherapy Group Trial 22921. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med. 2006 Sep;355(11):1114–23. https://doi.org/10.1056/NEJMoa060829
  9. Stillwell AP, Buettner PG, Ho YH. Meta-analysis of survival of patients with stage IV colorectal cancer managed with surgical resection versus chemotherapy alone. World J Surg. 2010 Apr;34(4):797–807. https://doi.org/10.1007/s00268-009-0366-y
  10. Fowler JF. Sensitivity analysis of parameters in linear-quadratic radiobiologic modeling. Int J Radiat Oncol Biol Phys. 2009 Apr;73(5):1532–7. https://doi.org/10.1016/j.ijrobp.2008.11.039
  11. Nahum AE. The radiobiology of hypofractionation. Clin Oncol (R Coll Radiol). 2015 May;27(5):260–9. https://doi.org/10.1016/j.clon.2015.02.001
  12. Common Terminology Criteria for Adverse Events (CTCAE) - CTCAE_4.03_2010-06-14_QuickReference_5x7.pdf [Internet]. [cited 2017 Feb 28]. Available 2017 Feb 28, from https://www.eortc.be/services/doc/ctc/CTCAE_4.03_2010-06-14_QuickReference_5x7.pdf
  13. Venderbosch S, de Wilt JH, Teerenstra S, Loosveld OJ, van Bochove A, Sinnige HA, et al. Prognostic value of resection of primary tumor in patients with stage IV colorectal cancer: retrospective analysis of two randomized studies and a review of the literature. Ann Surg Oncol. 2011 Nov;18(12):3252–60. https://doi.org/10.1245/s10434-011-1951-5
  14. Ferrand F, Malka D, Bourredjem A, Allonier C, Bouché O, Louafi S, et al. Impact of primary tumour resection on survival of patients with colorectal cancer and synchronous metastases treated by chemotherapy: results from the multicenter, randomised trial Fédération Francophone de Cancérologie Digestive 9601. Eur J Cancer. 2013 Jan;49(1):90–7. https://doi.org/10.1016/j.ejca.2012.07.006
  15. Gresham G, Renouf DJ, Chan M, Kennecke HF, Lim HJ, Brown C, et al. Association between palliative resection of the primary tumor and overall survival in a population-based cohort of metastatic colorectal cancer patients. Ann Surg Oncol. 2014 Nov;21(12):3917–23. https://doi.org/10.1245/s10434-014-3797-0
  16. Ishihara S, Hayama T, Yamada H, Nozawa K, Matsuda K, Miyata H, et al. Prognostic impact of primary tumor resection and lymph node dissection in stage IV colorectal cancer with unresectable metastasis: a propensity score analysis in a multicenter retrospective study. Ann Surg Oncol. 2014 Sep;21(9):2949–55. https://doi.org/10.1245/s10434-014-3719-1
  17. Norton L, Massagué J. Is cancer a disease of self-seeding? Nat Med. 2006 Aug;12(8):875–8. https://doi.org/10.1038/nm0806-875
  18. Kim MY, Oskarsson T, Acharyya S, Nguyen DX, Zhang XH, Norton L, et al. Tumor self-seeding by circulating cancer cells. Cell. 2009 Dec;139(7):1315–26. https://doi.org/10.1016/j.cell.2009.11.025
  19. Danna EA, Sinha P, Gilbert M, Clements VK, Pulaski BA, Ostrand-Rosenberg S. Surgical removal of primary tumor reverses tumor-induced immunosuppression despite the presence of metastatic disease. Cancer Res. 2004 Mar;64(6):2205–11. https://doi.org/10.1158/0008-5472.CAN-03-2646
  20. Gérard JP, Conroy T, Bonnetain F, Bouché O, Chapet O, Closon-Dejardin MT, et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol. 2006 Oct;24(28):4620–5. https://doi.org/10.1200/JCO.2006.06.7629
  21. Meta-analysis of survival of patients with stage IV colorectal cancer managed with surgical resection versus chemotherapy alone. - PubMed - NCBI [Internet]. [Cited 2018 Jul 13]. Available in 2018 Jul 13, from: https://www.ncbi.nlm.nih.gov/pubmed/?term=Stillwell+AP%2C+Buettner+PG%2C+Ho+YH.+Meta-analysis+of+survival+of+patients+with
  22. Stelzner S, Hellmich G, Koch R, Ludwig K. Factors predicting survival in stage IV colorectal carcinoma patients after palliative treatment: a multivariate analysis. J Surg Oncol. 2005 Mar;89(4):211–7. https://doi.org/10.1002/jso.20196

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