Impact of T and N Stage and Treatment on Survival and Relapse in Adjuvant Rectal Cancer A Pooled Analysis
To determine survival and relapse rates by T and N stage and treatment method in five randomized phase III North American rectal adjuvant studies. Data were pooled from 3,791 eligible patients enrolled onto North Central Cancer Treatment Group (NCCTG) 79-47-51, NCCTG 86-47-51, US Gastrointestinal In...
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| Veröffentlicht in: | Journal of clinical oncology 2004-05, Vol.22 (10), p.1785-1796 |
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| creator | GUNDERSON, Leonard L SARGENT, Daniel J MARTENSON, James A MAYER, Robert J RICH, Tyvin A AJANI, Jaffer A MACDONALD, John S WILLETT, Christopher G GOLDBERG, Richard M TEPPER, Joel E WOLMARK, Norman O'CONNELL, Michael J BEGOVIC, Mirsada ALLMER, Cristine COLANGELO, Linda SMALLEY, Steven R HALLER, Daniel G |
| description | To determine survival and relapse rates by T and N stage and treatment method in five randomized phase III North American rectal adjuvant studies.
Data were pooled from 3,791 eligible patients enrolled onto North Central Cancer Treatment Group (NCCTG) 79-47-51, NCCTG 86-47-51, US Gastrointestinal Intergroup 0114, National Surgical Adjuvant Breast and Bowel Project (NSABP) R01, and NSABP R02. Surgery alone (S) was the treatment arm in 179 patients. The remaining patients received adjuvant treatment as follows: irradiation (RT) alone (n = 281), RT + fluorouracil (FU) +/- semustine bolus chemotherapy (CT; n = 779), RT + protracted venous infusion CT (n = 325), RT + FU +/- leucovorin or levamisole bolus CT (n = 1,695), or CT alone (n = 532). Five-year follow-up was available in 94% of surviving patients, and 8-year follow-up, in 62%.
Overall (OS) and disease-free survival were dependent on TN stage, NT stage, and treatment method. Even among N2 patients, T substage influenced 5-year OS (T1-2, 67%; T3, 44%; T4, 37%; P |
| doi_str_mv | 10.1200/JCO.2004.08.173 |
| format | Article |
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Data were pooled from 3,791 eligible patients enrolled onto North Central Cancer Treatment Group (NCCTG) 79-47-51, NCCTG 86-47-51, US Gastrointestinal Intergroup 0114, National Surgical Adjuvant Breast and Bowel Project (NSABP) R01, and NSABP R02. Surgery alone (S) was the treatment arm in 179 patients. The remaining patients received adjuvant treatment as follows: irradiation (RT) alone (n = 281), RT + fluorouracil (FU) +/- semustine bolus chemotherapy (CT; n = 779), RT + protracted venous infusion CT (n = 325), RT + FU +/- leucovorin or levamisole bolus CT (n = 1,695), or CT alone (n = 532). Five-year follow-up was available in 94% of surviving patients, and 8-year follow-up, in 62%.
Overall (OS) and disease-free survival were dependent on TN stage, NT stage, and treatment method. Even among N2 patients, T substage influenced 5-year OS (T1-2, 67%; T3, 44%; T4, 37%; P <.001). Three risk groups of patients were defined: (1) intermediate (T1-2/N1, T3/N0), (2) moderately high (T1-2/N2, T3/N1, T4/N0), and (3) high (T3/N2, T4/N1, T4/N2). For intermediate-risk patients, those receiving S plus CT had 5-year OS rates of 85% (T1-2/N1) and 84% (T3/N0), which was similar to results with S plus RT plus CT (T1-2/N1, 78% to 83%; T3/N0, 74% to 80%). For moderately high-risk lesions, 5-year OS ranged from 43% to 70% with S plus CT, and 44% to 80% with S plus RT plus CT. For high-risk lesions, 5-year OS ranged from 25% to 45% with S plus CT, and 29% to 57% with S plus RT plus CT.
Different treatment strategies may be indicated for intermediate-risk versus moderately high- or high-risk patients based on differential survival rates and rates of relapse. Use of trimodality treatment for all patients with intermediate-risk lesions may be excessive, since S plus CT resulted in 5-year OS of approximately 85%; however, 5-year disease-free survival rates with S plus CT were 78% (T1-2/N1) and 69%(T3/N0), indicating room for improvement.</description><identifier>ISSN: 0732-183X</identifier><identifier>EISSN: 1527-7755</identifier><identifier>DOI: 10.1200/JCO.2004.08.173</identifier><identifier>PMID: 15067027</identifier><language>eng</language><publisher>Baltimore, MD: American Society of Clinical Oncology</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Clinical Trials, Phase III as Topic ; Combined Modality Therapy ; Databases, Factual ; Decision Making ; Disease-Free Survival ; Female ; Gastroenterology. Liver. Pancreas. Abdomen ; Humans ; Lymphatic Metastasis ; Male ; Medical Records ; Medical sciences ; Middle Aged ; Neoplasm Recurrence, Local - mortality ; Neoplasm Recurrence, Local - pathology ; Neoplasm Recurrence, Local - therapy ; Neoplasm Staging - methods ; Randomized Controlled Trials as Topic ; Rectal Neoplasms - mortality ; Rectal Neoplasms - pathology ; Rectal Neoplasms - therapy ; Retrospective Studies ; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus ; Survival Analysis ; Tumors ; United States - epidemiology</subject><ispartof>Journal of clinical oncology, 2004-05, Vol.22 (10), p.1785-1796</ispartof><rights>2004 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c315t-33ce81851295340a22eae92029d01a4b98a4ec0a03feee3250a74dfe6e3cabf33</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>309,310,314,778,782,787,788,23917,23918,25127,27911,27912</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=15764674$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15067027$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>GUNDERSON, Leonard L</creatorcontrib><creatorcontrib>SARGENT, Daniel J</creatorcontrib><creatorcontrib>MARTENSON, James A</creatorcontrib><creatorcontrib>MAYER, Robert J</creatorcontrib><creatorcontrib>RICH, Tyvin A</creatorcontrib><creatorcontrib>AJANI, Jaffer A</creatorcontrib><creatorcontrib>MACDONALD, John S</creatorcontrib><creatorcontrib>WILLETT, Christopher G</creatorcontrib><creatorcontrib>GOLDBERG, Richard M</creatorcontrib><creatorcontrib>TEPPER, Joel E</creatorcontrib><creatorcontrib>WOLMARK, Norman</creatorcontrib><creatorcontrib>O'CONNELL, Michael J</creatorcontrib><creatorcontrib>BEGOVIC, Mirsada</creatorcontrib><creatorcontrib>ALLMER, Cristine</creatorcontrib><creatorcontrib>COLANGELO, Linda</creatorcontrib><creatorcontrib>SMALLEY, Steven R</creatorcontrib><creatorcontrib>HALLER, Daniel G</creatorcontrib><title>Impact of T and N Stage and Treatment on Survival and Relapse in Adjuvant Rectal Cancer A Pooled Analysis</title><title>Journal of clinical oncology</title><addtitle>J Clin Oncol</addtitle><description>To determine survival and relapse rates by T and N stage and treatment method in five randomized phase III North American rectal adjuvant studies.
Data were pooled from 3,791 eligible patients enrolled onto North Central Cancer Treatment Group (NCCTG) 79-47-51, NCCTG 86-47-51, US Gastrointestinal Intergroup 0114, National Surgical Adjuvant Breast and Bowel Project (NSABP) R01, and NSABP R02. Surgery alone (S) was the treatment arm in 179 patients. The remaining patients received adjuvant treatment as follows: irradiation (RT) alone (n = 281), RT + fluorouracil (FU) +/- semustine bolus chemotherapy (CT; n = 779), RT + protracted venous infusion CT (n = 325), RT + FU +/- leucovorin or levamisole bolus CT (n = 1,695), or CT alone (n = 532). Five-year follow-up was available in 94% of surviving patients, and 8-year follow-up, in 62%.
Overall (OS) and disease-free survival were dependent on TN stage, NT stage, and treatment method. Even among N2 patients, T substage influenced 5-year OS (T1-2, 67%; T3, 44%; T4, 37%; P <.001). Three risk groups of patients were defined: (1) intermediate (T1-2/N1, T3/N0), (2) moderately high (T1-2/N2, T3/N1, T4/N0), and (3) high (T3/N2, T4/N1, T4/N2). For intermediate-risk patients, those receiving S plus CT had 5-year OS rates of 85% (T1-2/N1) and 84% (T3/N0), which was similar to results with S plus RT plus CT (T1-2/N1, 78% to 83%; T3/N0, 74% to 80%). For moderately high-risk lesions, 5-year OS ranged from 43% to 70% with S plus CT, and 44% to 80% with S plus RT plus CT. For high-risk lesions, 5-year OS ranged from 25% to 45% with S plus CT, and 29% to 57% with S plus RT plus CT.
Different treatment strategies may be indicated for intermediate-risk versus moderately high- or high-risk patients based on differential survival rates and rates of relapse. Use of trimodality treatment for all patients with intermediate-risk lesions may be excessive, since S plus CT resulted in 5-year OS of approximately 85%; however, 5-year disease-free survival rates with S plus CT were 78% (T1-2/N1) and 69%(T3/N0), indicating room for improvement.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Clinical Trials, Phase III as Topic</subject><subject>Combined Modality Therapy</subject><subject>Databases, Factual</subject><subject>Decision Making</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Humans</subject><subject>Lymphatic Metastasis</subject><subject>Male</subject><subject>Medical Records</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Neoplasm Recurrence, Local - mortality</subject><subject>Neoplasm Recurrence, Local - pathology</subject><subject>Neoplasm Recurrence, Local - therapy</subject><subject>Neoplasm Staging - methods</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Rectal Neoplasms - mortality</subject><subject>Rectal Neoplasms - pathology</subject><subject>Rectal Neoplasms - therapy</subject><subject>Retrospective Studies</subject><subject>Stomach. Duodenum. Small intestine. Colon. Rectum. Anus</subject><subject>Survival Analysis</subject><subject>Tumors</subject><subject>United States - epidemiology</subject><issn>0732-183X</issn><issn>1527-7755</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpNkEtLw0AUhQdRtFbX7mQ26ip1HplOsizFR0VU2gruwu3kRqdMkppJKv57x7aCq3Ph-zhwDyFnnA24YOz6Yfw8CBkPWDLgWu6RHldCR1ortU96TEsR8US-HZFj75eM8TiR6pAcccWGmgndI3ZSrsC0tC7onEKV0yc6a-EdN_e8QWhLrAKu6Kxr1nYNbkOm6GDlkdqKjvJlt4bgTNG0AY-hMtjQEX2pa4c5HVXgvr31J-SgAOfxdJd98np7Mx_fR4_Pd5Px6DEykqs2ktJgwhPFRapkzEAIBEwFE2nOOMSLNIEYDQMmC0SUQjHQcV7gEKWBRSFln1xue1dN_dmhb7PSeoPOQYV15zPNUxmmioN4vhO7RYl5tmpsCc139jdOEC52AngDrmjCZ9b_8_QwHurfoqut92HfP75sg5kvwblQK7KlqYXIOMu4TpT8Af-Hf4g</recordid><startdate>20040515</startdate><enddate>20040515</enddate><creator>GUNDERSON, Leonard L</creator><creator>SARGENT, Daniel J</creator><creator>MARTENSON, James A</creator><creator>MAYER, Robert J</creator><creator>RICH, Tyvin A</creator><creator>AJANI, Jaffer A</creator><creator>MACDONALD, John S</creator><creator>WILLETT, Christopher G</creator><creator>GOLDBERG, Richard M</creator><creator>TEPPER, Joel E</creator><creator>WOLMARK, Norman</creator><creator>O'CONNELL, Michael J</creator><creator>BEGOVIC, Mirsada</creator><creator>ALLMER, Cristine</creator><creator>COLANGELO, Linda</creator><creator>SMALLEY, Steven R</creator><creator>HALLER, Daniel G</creator><general>American Society of Clinical Oncology</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>20040515</creationdate><title>Impact of T and N Stage and Treatment on Survival and Relapse in Adjuvant Rectal Cancer A Pooled Analysis</title><author>GUNDERSON, Leonard L ; SARGENT, Daniel J ; MARTENSON, James A ; MAYER, Robert J ; RICH, Tyvin A ; AJANI, Jaffer A ; MACDONALD, John S ; WILLETT, Christopher G ; GOLDBERG, Richard M ; TEPPER, Joel E ; WOLMARK, Norman ; O'CONNELL, Michael J ; BEGOVIC, Mirsada ; ALLMER, Cristine ; COLANGELO, Linda ; SMALLEY, Steven R ; HALLER, Daniel G</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c315t-33ce81851295340a22eae92029d01a4b98a4ec0a03feee3250a74dfe6e3cabf33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Clinical Trials, Phase III as Topic</topic><topic>Combined Modality Therapy</topic><topic>Databases, Factual</topic><topic>Decision Making</topic><topic>Disease-Free Survival</topic><topic>Female</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>Humans</topic><topic>Lymphatic Metastasis</topic><topic>Male</topic><topic>Medical Records</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Neoplasm Recurrence, Local - mortality</topic><topic>Neoplasm Recurrence, Local - pathology</topic><topic>Neoplasm Recurrence, Local - therapy</topic><topic>Neoplasm Staging - methods</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Rectal Neoplasms - mortality</topic><topic>Rectal Neoplasms - pathology</topic><topic>Rectal Neoplasms - therapy</topic><topic>Retrospective Studies</topic><topic>Stomach. Duodenum. Small intestine. Colon. Rectum. Anus</topic><topic>Survival Analysis</topic><topic>Tumors</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>GUNDERSON, Leonard L</creatorcontrib><creatorcontrib>SARGENT, Daniel J</creatorcontrib><creatorcontrib>MARTENSON, James A</creatorcontrib><creatorcontrib>MAYER, Robert J</creatorcontrib><creatorcontrib>RICH, Tyvin A</creatorcontrib><creatorcontrib>AJANI, Jaffer A</creatorcontrib><creatorcontrib>MACDONALD, John S</creatorcontrib><creatorcontrib>WILLETT, Christopher G</creatorcontrib><creatorcontrib>GOLDBERG, Richard M</creatorcontrib><creatorcontrib>TEPPER, Joel E</creatorcontrib><creatorcontrib>WOLMARK, Norman</creatorcontrib><creatorcontrib>O'CONNELL, Michael J</creatorcontrib><creatorcontrib>BEGOVIC, Mirsada</creatorcontrib><creatorcontrib>ALLMER, Cristine</creatorcontrib><creatorcontrib>COLANGELO, Linda</creatorcontrib><creatorcontrib>SMALLEY, Steven R</creatorcontrib><creatorcontrib>HALLER, Daniel G</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of clinical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>GUNDERSON, Leonard L</au><au>SARGENT, Daniel J</au><au>MARTENSON, James A</au><au>MAYER, Robert J</au><au>RICH, Tyvin A</au><au>AJANI, Jaffer A</au><au>MACDONALD, John S</au><au>WILLETT, Christopher G</au><au>GOLDBERG, Richard M</au><au>TEPPER, Joel E</au><au>WOLMARK, Norman</au><au>O'CONNELL, Michael J</au><au>BEGOVIC, Mirsada</au><au>ALLMER, Cristine</au><au>COLANGELO, Linda</au><au>SMALLEY, Steven R</au><au>HALLER, Daniel G</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of T and N Stage and Treatment on Survival and Relapse in Adjuvant Rectal Cancer A Pooled Analysis</atitle><jtitle>Journal of clinical oncology</jtitle><addtitle>J Clin Oncol</addtitle><date>2004-05-15</date><risdate>2004</risdate><volume>22</volume><issue>10</issue><spage>1785</spage><epage>1796</epage><pages>1785-1796</pages><issn>0732-183X</issn><eissn>1527-7755</eissn><abstract>To determine survival and relapse rates by T and N stage and treatment method in five randomized phase III North American rectal adjuvant studies.
Data were pooled from 3,791 eligible patients enrolled onto North Central Cancer Treatment Group (NCCTG) 79-47-51, NCCTG 86-47-51, US Gastrointestinal Intergroup 0114, National Surgical Adjuvant Breast and Bowel Project (NSABP) R01, and NSABP R02. Surgery alone (S) was the treatment arm in 179 patients. The remaining patients received adjuvant treatment as follows: irradiation (RT) alone (n = 281), RT + fluorouracil (FU) +/- semustine bolus chemotherapy (CT; n = 779), RT + protracted venous infusion CT (n = 325), RT + FU +/- leucovorin or levamisole bolus CT (n = 1,695), or CT alone (n = 532). Five-year follow-up was available in 94% of surviving patients, and 8-year follow-up, in 62%.
Overall (OS) and disease-free survival were dependent on TN stage, NT stage, and treatment method. Even among N2 patients, T substage influenced 5-year OS (T1-2, 67%; T3, 44%; T4, 37%; P <.001). Three risk groups of patients were defined: (1) intermediate (T1-2/N1, T3/N0), (2) moderately high (T1-2/N2, T3/N1, T4/N0), and (3) high (T3/N2, T4/N1, T4/N2). For intermediate-risk patients, those receiving S plus CT had 5-year OS rates of 85% (T1-2/N1) and 84% (T3/N0), which was similar to results with S plus RT plus CT (T1-2/N1, 78% to 83%; T3/N0, 74% to 80%). For moderately high-risk lesions, 5-year OS ranged from 43% to 70% with S plus CT, and 44% to 80% with S plus RT plus CT. For high-risk lesions, 5-year OS ranged from 25% to 45% with S plus CT, and 29% to 57% with S plus RT plus CT.
Different treatment strategies may be indicated for intermediate-risk versus moderately high- or high-risk patients based on differential survival rates and rates of relapse. Use of trimodality treatment for all patients with intermediate-risk lesions may be excessive, since S plus CT resulted in 5-year OS of approximately 85%; however, 5-year disease-free survival rates with S plus CT were 78% (T1-2/N1) and 69%(T3/N0), indicating room for improvement.</abstract><cop>Baltimore, MD</cop><pub>American Society of Clinical Oncology</pub><pmid>15067027</pmid><doi>10.1200/JCO.2004.08.173</doi><tpages>12</tpages></addata></record> |
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| source | MEDLINE; American Society of Clinical Oncology Online Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Adult Aged Aged, 80 and over Biological and medical sciences Clinical Trials, Phase III as Topic Combined Modality Therapy Databases, Factual Decision Making Disease-Free Survival Female Gastroenterology. Liver. Pancreas. Abdomen Humans Lymphatic Metastasis Male Medical Records Medical sciences Middle Aged Neoplasm Recurrence, Local - mortality Neoplasm Recurrence, Local - pathology Neoplasm Recurrence, Local - therapy Neoplasm Staging - methods Randomized Controlled Trials as Topic Rectal Neoplasms - mortality Rectal Neoplasms - pathology Rectal Neoplasms - therapy Retrospective Studies Stomach. Duodenum. Small intestine. Colon. Rectum. Anus Survival Analysis Tumors United States - epidemiology |
| title | Impact of T and N Stage and Treatment on Survival and Relapse in Adjuvant Rectal Cancer A Pooled Analysis |
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