Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2004-05-15
Impact of T and N stage and treatment on survival and relapse in adjuvant rectal cancer: a pooled analysis.
ABSTRACT
PURPOSE
To determine survival and relapse rates by T and N stage and treatment method in five randomized phase III North American rectal adjuvant studies.
PATIENTS AND METHODS
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%.
RESULTS
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.
CONCLUSION
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.
Related Questions
Fore example for a T3N0 rectal cancer on EUS?
New answer by Radiation Oncologist at University of North Carolina at Chapel Hill (May 3, 2015)
As is true for most complicated clinical situations, there is not any absolute answer to this question.First, it does allow me to remind everyone that prostate radiation thera...
Or should total neoadjuvant therapy be reserved for bulkier disease (T4N2)?
New answer by Radiation Oncologist at Memorial Sloan-Kettering Cancer Center (July 31, 2019)
There are a couple of points of clarification regarding cT3N0 that I think should be made. In colon cancer, only a small and almost unidentifiable subset of patients with stag...
Assuming all other factors are favorable (pT1-2, TME, negative margins).
New comment by Radiation Oncologist at Washington University School of Medicine ( March 31, 2021)
Postoperative RT can be given after completing adjuvant chemotherapy. We need not interfere with chemotherapy. This means that a decision on RT for a case like this can be bas...
What do you recommend if the patient would need an APR because of anal sphincter involvement and/or would like to attempt non-operative management?
New answer by Radiation Oncologist at Emeritus Professor (June 29, 2021)
Agree with Dr. @Eric D. Miller's response to the two question combination and the need for patients to be seen by all 3 specialties before initiation of any treatment (Ra...
Final pathology showed pT3N0, 0/27 nodes, negative margins +perforation, +PNI, pMMR.
New comment by Radiation Oncologist at UT Southwestern Medical Center ( April 21, 2022)
Per ASTRO guidelines for pre-op RT, the following scenarios would be appropriate to consider omission of RT in the PRE-op setting: T3a/b, N0, >10 cm from the anal verge, no...
If the patient is amenable to adjuvant chemotherapy alone, but is worried about chronic diarrhea/urgency after radiation, how would you counsel them?
New comment by Radiation Oncologist at Northeast Radiation Oncology ( January 28, 2023)
Very helpful discussion, thank you.
Staging/pre-op MRI only showed mild non-specific thickening.
New answer by Medical Oncologist at The Center for Hematology and Oncology at Holy Cross Hospital (July 28, 2023)
Would use cDNA to determine the need for any adjuvant therapy.
What factors might play into this decision?
New answer by Medical Oncologist at Mary Lanning Healthcare Morrison Cancer Center/University of Nebraska Medical Center Adjunct Faculty (January 14, 2024)
Neoadjuvant/adjuvant therapy of stage II (T3–4, node-negative disease with tumor penetration through the muscle wall) or stage III (node-positive disease without distant...