Park H. Predictive factors for early distant metastasis after neoadjuvant chemoradiotherapy in locally advanced rectal cancer. World J Gastrointest Oncol 2021; 13(4): 252-264 [PMID: 33889277 DOI: 10.4251/wjgo.v13.i4.252]
Corresponding Author of This Article
Hyojung Park, MD, Doctor, Departments of Radiation Oncology, Dankook University Hospital, Dankook University College of Medicine, 201 Manghyang-ro, Dongnam-gu, Cheonan 46115, South Korea. hj0714.park@dkuh.co.kr
Research Domain of This Article
Oncology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Oncol. Apr 15, 2021; 13(4): 252-264 Published online Apr 15, 2021. doi: 10.4251/wjgo.v13.i4.252
Predictive factors for early distant metastasis after neoadjuvant chemoradiotherapy in locally advanced rectal cancer
Hyojung Park
Hyojung Park, Departments of Radiation Oncology, Dankook University Hospital, Dankook University College of Medicine, Cheonan 46115, South Korea
Author contributions: Park H analyzed the data and wrote the manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Dankook University Hospital.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors have no conflicts to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hyojung Park, MD, Doctor, Departments of Radiation Oncology, Dankook University Hospital, Dankook University College of Medicine, 201 Manghyang-ro, Dongnam-gu, Cheonan 46115, South Korea. hj0714.park@dkuh.co.kr
Received: September 10, 2020 Peer-review started: September 10, 2020 First decision: November 3, 2020 Revised: January 11, 2021 Accepted: March 16, 2021 Article in press: March 16, 2021 Published online: April 15, 2021
ARTICLE HIGHLIGHTS
Research background
Distant relapse has become the leading cause of cancer death in locally advanced rectal cancer. The standard treatment of locally advanced rectal cancer, neoadjuvant chemoradiation (NACRT) followed by surgery, inevitably delays delivery of systemic treatment.
Research motivation
This study investigated prognostic factors for distant metastasis, especially early distant metastasis, using the standard treatment paradigm to identify the most effective treatments according to recurrence risk.
Research objectives
We investigated prognostic factors for early distant metastasis, using the standard treatment paradigm to identify the most effective neoadjuvant treatments according to recurrence risk.
Research methods
The authors retrieved data from 148 consecutive rectal cancer patients from January 2015 through December 2019 who underwent NACRT for having clinical T 3-4 or clinical N 1-2 disease according to the 8th American Joint Committee on Cancer staging system.
Research results
Patients with early distant metastasis were more likely to have poorly differentiated tumor (P = 0.025), tumors with involved mesorectal fascia (P = 0.002), and extramural venous invasion (P = 0.012) than those who did not. Due to the small number of patients who received magnetic resonance imaging and inherent limitation of retrospective study, prospective studies with large number of patients are needed.
Research conclusions
For patients with risk factors for early distant metastasis, early systemic chemotherapy could be beneficial. According to the risk factors, neoadjuvant treatment should be individualized.
Research perspectives
Future studies that include carefully applied imaging and randomized design are required.
