Adjuvant chemoradiotherapy instead of revision radical resection after local excision for high-risk early rectal cancer
After local excision of early rectal cancer, revision radical resection is recommended for patients with high-risk pathologic stage T1 (pT1) or pT2 cancer, but the revision procedure has high morbidity rates. We evaluated the efficacy of adjuvant concurrent chemoradiotherapy (CCRT) for reducing recu...
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| Veröffentlicht in: | Radiation oncology (London, England) England), 2016-09, Vol.11 (1), p.114-114, Article 114 |
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| creator | Jeong, Jae-Uk Nam, Taek-Keun Kim, Hyeong-Rok Shim, Hyun-Jeong Kim, Yong-Hyub Yoon, Mee Sun Song, Ju-Young Ahn, Sung-Ja Chung, Woong-Ki |
| description | After local excision of early rectal cancer, revision radical resection is recommended for patients with high-risk pathologic stage T1 (pT1) or pT2 cancer, but the revision procedure has high morbidity rates. We evaluated the efficacy of adjuvant concurrent chemoradiotherapy (CCRT) for reducing recurrence after local excision in these patients.
Eighty-three patients with high-risk pT1 or pT2 rectal cancer underwent postoperative adjuvant CCRT after local excision. We defined high-risk features as pT1 having tumor size ≤3 cm, and/or resection margin (RM) ≤3 mm, and/or lymphovascular invasion (LVI), and/or non-full thickness excision such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), or unknown records regarding those features, or pT2 cancer. Radiotherapy was administered with a median dose of 50.4 Gy in 1.8 Gy fraction size over 5-7 weeks. Concurrent 5-fluorouracil and leucovorin were administered for 4 days in the first and fifth weeks of radiotherapy.
The median interval between local excision and radiotherapy was 34 (range, 11-104) days. Fifteen patients (18.1 %) had stage pT2 tumors, 22 (26.5 %) had RM of ≥3 mm, and 21 (25.3 %) had tumors of ≥3 cm in size. Thirteen patients (15.7 %) had LVI. Transanal excision was performed in 58 patients (69.9 %) and 25 patients (30.1 %) underwent EMR or ESD. The median follow-up was 61 months. The 5-year overall survival (OS), locoregional relapse-free survival (LRFS), and disease-free survival (DFS) rates for all patients were 94.9, 91.0, and 89.8 %, respectively. Multivariate analysis did not identify any significant factors for OS or LRFS, but the only significant factor affecting DFS was the pT stage (p = 0.027).
In patients with high-risk pT1 rectal cancer, adjuvant CCRT after local excision could be an effective alternative treatment instead of revision radical resection. However, patients with pT2 stage showed inferior DFS compared to pT1. |
| doi_str_mv | 10.1186/s13014-016-0692-9 |
| format | Article |
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Eighty-three patients with high-risk pT1 or pT2 rectal cancer underwent postoperative adjuvant CCRT after local excision. We defined high-risk features as pT1 having tumor size ≤3 cm, and/or resection margin (RM) ≤3 mm, and/or lymphovascular invasion (LVI), and/or non-full thickness excision such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), or unknown records regarding those features, or pT2 cancer. Radiotherapy was administered with a median dose of 50.4 Gy in 1.8 Gy fraction size over 5-7 weeks. Concurrent 5-fluorouracil and leucovorin were administered for 4 days in the first and fifth weeks of radiotherapy.
The median interval between local excision and radiotherapy was 34 (range, 11-104) days. Fifteen patients (18.1 %) had stage pT2 tumors, 22 (26.5 %) had RM of ≥3 mm, and 21 (25.3 %) had tumors of ≥3 cm in size. Thirteen patients (15.7 %) had LVI. Transanal excision was performed in 58 patients (69.9 %) and 25 patients (30.1 %) underwent EMR or ESD. The median follow-up was 61 months. The 5-year overall survival (OS), locoregional relapse-free survival (LRFS), and disease-free survival (DFS) rates for all patients were 94.9, 91.0, and 89.8 %, respectively. Multivariate analysis did not identify any significant factors for OS or LRFS, but the only significant factor affecting DFS was the pT stage (p = 0.027).
In patients with high-risk pT1 rectal cancer, adjuvant CCRT after local excision could be an effective alternative treatment instead of revision radical resection. However, patients with pT2 stage showed inferior DFS compared to pT1.</description><identifier>ISSN: 1748-717X</identifier><identifier>EISSN: 1748-717X</identifier><identifier>DOI: 10.1186/s13014-016-0692-9</identifier><identifier>PMID: 27595767</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Adjuvant treatment ; Adult ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; Cancer ; Chemoradiotherapy, Adjuvant - methods ; Colorectal cancer ; Disease-Free Survival ; Drug therapy ; Endoscopy ; Female ; Fluorouracil - administration & dosage ; Humans ; Leucovorin - administration & dosage ; Male ; Middle Aged ; Neoplasm Recurrence, Local - pathology ; Patient outcomes ; Postoperative Period ; Prognosis ; Radiotherapy ; Rectal Neoplasms - drug therapy ; Rectal Neoplasms - pathology ; Rectal Neoplasms - surgery ; Risk ; Surgical Oncology - methods ; Treatment Outcome</subject><ispartof>Radiation oncology (London, England), 2016-09, Vol.11 (1), p.114-114, Article 114</ispartof><rights>COPYRIGHT 2016 BioMed Central Ltd.</rights><rights>Copyright BioMed Central 2016</rights><rights>The Author(s). 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c494t-34023505559961bef162b0f0037e50f7f07f2abc6b6fe86b4357d4f2ce915dbc3</citedby><cites>FETCH-LOGICAL-c494t-34023505559961bef162b0f0037e50f7f07f2abc6b6fe86b4357d4f2ce915dbc3</cites><orcidid>0000-0003-1229-8468</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5011790/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5011790/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27595767$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jeong, Jae-Uk</creatorcontrib><creatorcontrib>Nam, Taek-Keun</creatorcontrib><creatorcontrib>Kim, Hyeong-Rok</creatorcontrib><creatorcontrib>Shim, Hyun-Jeong</creatorcontrib><creatorcontrib>Kim, Yong-Hyub</creatorcontrib><creatorcontrib>Yoon, Mee Sun</creatorcontrib><creatorcontrib>Song, Ju-Young</creatorcontrib><creatorcontrib>Ahn, Sung-Ja</creatorcontrib><creatorcontrib>Chung, Woong-Ki</creatorcontrib><title>Adjuvant chemoradiotherapy instead of revision radical resection after local excision for high-risk early rectal cancer</title><title>Radiation oncology (London, England)</title><addtitle>Radiat Oncol</addtitle><description>After local excision of early rectal cancer, revision radical resection is recommended for patients with high-risk pathologic stage T1 (pT1) or pT2 cancer, but the revision procedure has high morbidity rates. We evaluated the efficacy of adjuvant concurrent chemoradiotherapy (CCRT) for reducing recurrence after local excision in these patients.
Eighty-three patients with high-risk pT1 or pT2 rectal cancer underwent postoperative adjuvant CCRT after local excision. We defined high-risk features as pT1 having tumor size ≤3 cm, and/or resection margin (RM) ≤3 mm, and/or lymphovascular invasion (LVI), and/or non-full thickness excision such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), or unknown records regarding those features, or pT2 cancer. Radiotherapy was administered with a median dose of 50.4 Gy in 1.8 Gy fraction size over 5-7 weeks. Concurrent 5-fluorouracil and leucovorin were administered for 4 days in the first and fifth weeks of radiotherapy.
The median interval between local excision and radiotherapy was 34 (range, 11-104) days. Fifteen patients (18.1 %) had stage pT2 tumors, 22 (26.5 %) had RM of ≥3 mm, and 21 (25.3 %) had tumors of ≥3 cm in size. Thirteen patients (15.7 %) had LVI. Transanal excision was performed in 58 patients (69.9 %) and 25 patients (30.1 %) underwent EMR or ESD. The median follow-up was 61 months. The 5-year overall survival (OS), locoregional relapse-free survival (LRFS), and disease-free survival (DFS) rates for all patients were 94.9, 91.0, and 89.8 %, respectively. Multivariate analysis did not identify any significant factors for OS or LRFS, but the only significant factor affecting DFS was the pT stage (p = 0.027).
In patients with high-risk pT1 rectal cancer, adjuvant CCRT after local excision could be an effective alternative treatment instead of revision radical resection. However, patients with pT2 stage showed inferior DFS compared to pT1.</description><subject>Adjuvant treatment</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</subject><subject>Cancer</subject><subject>Chemoradiotherapy, Adjuvant - methods</subject><subject>Colorectal cancer</subject><subject>Disease-Free Survival</subject><subject>Drug therapy</subject><subject>Endoscopy</subject><subject>Female</subject><subject>Fluorouracil - administration & dosage</subject><subject>Humans</subject><subject>Leucovorin - administration & dosage</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoplasm Recurrence, Local - pathology</subject><subject>Patient outcomes</subject><subject>Postoperative Period</subject><subject>Prognosis</subject><subject>Radiotherapy</subject><subject>Rectal Neoplasms - drug therapy</subject><subject>Rectal Neoplasms - pathology</subject><subject>Rectal Neoplasms - surgery</subject><subject>Risk</subject><subject>Surgical Oncology - methods</subject><subject>Treatment Outcome</subject><issn>1748-717X</issn><issn>1748-717X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNptkktv1DAUhSMEoqXwA9igSGzYpFwnfsQbpFHFS6rEBiR2luNcTzwk9mAnU-bf42hKaRHywtbxd44fOkXxksAlIS1_m0gDhFZAeAVc1pV8VJwTQdtKEPH98b31WfEspR0AZQ3Ip8VZLZhkgovz4mbT75aD9nNpBpxC1L0L84BR74-l82lG3ZfBlhEPLrngyxUwesxCQjOvirYzxnIMq4q_zAmzIZaD2w5VdOlHiTqOx2wxc2aM9gbj8-KJ1WPCF7fzRfHtw_uvV5-q6y8fP19tritDJZ2rhkLdMGCMSclJh5bwugML0AhkYIUFYWvdGd5xiy3vaMNET21tUBLWd6a5KN6dcvdLN2Fv0M9Rj2of3aTjUQXt1MMd7wa1DQfFgBAhIQe8uQ2I4eeCaVaTSwbHUXsMS1KkJSJfj1Ge0df_oLuwRJ-flykKbctpS_9SWz2ict6GfK5ZQ9WGcs4EAK8zdfkfKo8eJ2eCR-uy_sBATgYTQ0oR7d0bCai1LerUFpXbota2KJk9r-5_zp3jTz2a31VVvBc</recordid><startdate>20160905</startdate><enddate>20160905</enddate><creator>Jeong, Jae-Uk</creator><creator>Nam, Taek-Keun</creator><creator>Kim, Hyeong-Rok</creator><creator>Shim, Hyun-Jeong</creator><creator>Kim, Yong-Hyub</creator><creator>Yoon, Mee Sun</creator><creator>Song, Ju-Young</creator><creator>Ahn, Sung-Ja</creator><creator>Chung, Woong-Ki</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>P64</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-1229-8468</orcidid></search><sort><creationdate>20160905</creationdate><title>Adjuvant chemoradiotherapy instead of revision radical resection after local excision for high-risk early rectal cancer</title><author>Jeong, Jae-Uk ; Nam, Taek-Keun ; Kim, Hyeong-Rok ; Shim, Hyun-Jeong ; Kim, Yong-Hyub ; Yoon, Mee Sun ; Song, Ju-Young ; Ahn, Sung-Ja ; Chung, Woong-Ki</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c494t-34023505559961bef162b0f0037e50f7f07f2abc6b6fe86b4357d4f2ce915dbc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adjuvant treatment</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</topic><topic>Cancer</topic><topic>Chemoradiotherapy, Adjuvant - methods</topic><topic>Colorectal cancer</topic><topic>Disease-Free Survival</topic><topic>Drug therapy</topic><topic>Endoscopy</topic><topic>Female</topic><topic>Fluorouracil - administration & dosage</topic><topic>Humans</topic><topic>Leucovorin - administration & dosage</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neoplasm Recurrence, Local - pathology</topic><topic>Patient outcomes</topic><topic>Postoperative Period</topic><topic>Prognosis</topic><topic>Radiotherapy</topic><topic>Rectal Neoplasms - drug therapy</topic><topic>Rectal Neoplasms - pathology</topic><topic>Rectal Neoplasms - surgery</topic><topic>Risk</topic><topic>Surgical Oncology - methods</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jeong, Jae-Uk</creatorcontrib><creatorcontrib>Nam, Taek-Keun</creatorcontrib><creatorcontrib>Kim, Hyeong-Rok</creatorcontrib><creatorcontrib>Shim, Hyun-Jeong</creatorcontrib><creatorcontrib>Kim, Yong-Hyub</creatorcontrib><creatorcontrib>Yoon, Mee Sun</creatorcontrib><creatorcontrib>Song, Ju-Young</creatorcontrib><creatorcontrib>Ahn, Sung-Ja</creatorcontrib><creatorcontrib>Chung, Woong-Ki</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Radiation oncology (London, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jeong, Jae-Uk</au><au>Nam, Taek-Keun</au><au>Kim, Hyeong-Rok</au><au>Shim, Hyun-Jeong</au><au>Kim, Yong-Hyub</au><au>Yoon, Mee Sun</au><au>Song, Ju-Young</au><au>Ahn, Sung-Ja</au><au>Chung, Woong-Ki</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Adjuvant chemoradiotherapy instead of revision radical resection after local excision for high-risk early rectal cancer</atitle><jtitle>Radiation oncology (London, England)</jtitle><addtitle>Radiat Oncol</addtitle><date>2016-09-05</date><risdate>2016</risdate><volume>11</volume><issue>1</issue><spage>114</spage><epage>114</epage><pages>114-114</pages><artnum>114</artnum><issn>1748-717X</issn><eissn>1748-717X</eissn><abstract>After local excision of early rectal cancer, revision radical resection is recommended for patients with high-risk pathologic stage T1 (pT1) or pT2 cancer, but the revision procedure has high morbidity rates. We evaluated the efficacy of adjuvant concurrent chemoradiotherapy (CCRT) for reducing recurrence after local excision in these patients.
Eighty-three patients with high-risk pT1 or pT2 rectal cancer underwent postoperative adjuvant CCRT after local excision. We defined high-risk features as pT1 having tumor size ≤3 cm, and/or resection margin (RM) ≤3 mm, and/or lymphovascular invasion (LVI), and/or non-full thickness excision such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), or unknown records regarding those features, or pT2 cancer. Radiotherapy was administered with a median dose of 50.4 Gy in 1.8 Gy fraction size over 5-7 weeks. Concurrent 5-fluorouracil and leucovorin were administered for 4 days in the first and fifth weeks of radiotherapy.
The median interval between local excision and radiotherapy was 34 (range, 11-104) days. Fifteen patients (18.1 %) had stage pT2 tumors, 22 (26.5 %) had RM of ≥3 mm, and 21 (25.3 %) had tumors of ≥3 cm in size. Thirteen patients (15.7 %) had LVI. Transanal excision was performed in 58 patients (69.9 %) and 25 patients (30.1 %) underwent EMR or ESD. The median follow-up was 61 months. The 5-year overall survival (OS), locoregional relapse-free survival (LRFS), and disease-free survival (DFS) rates for all patients were 94.9, 91.0, and 89.8 %, respectively. Multivariate analysis did not identify any significant factors for OS or LRFS, but the only significant factor affecting DFS was the pT stage (p = 0.027).
In patients with high-risk pT1 rectal cancer, adjuvant CCRT after local excision could be an effective alternative treatment instead of revision radical resection. However, patients with pT2 stage showed inferior DFS compared to pT1.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>27595767</pmid><doi>10.1186/s13014-016-0692-9</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0003-1229-8468</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adjuvant treatment Adult Aged Aged, 80 and over Antineoplastic Combined Chemotherapy Protocols - therapeutic use Cancer Chemoradiotherapy, Adjuvant - methods Colorectal cancer Disease-Free Survival Drug therapy Endoscopy Female Fluorouracil - administration & dosage Humans Leucovorin - administration & dosage Male Middle Aged Neoplasm Recurrence, Local - pathology Patient outcomes Postoperative Period Prognosis Radiotherapy Rectal Neoplasms - drug therapy Rectal Neoplasms - pathology Rectal Neoplasms - surgery Risk Surgical Oncology - methods Treatment Outcome |
| title | Adjuvant chemoradiotherapy instead of revision radical resection after local excision for high-risk early rectal cancer |
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