New trends in neoadjuvant therapy of locally advanced rectal cancer from a surgeon’s perspective – a commentary

Česká verzia

Authors: prof. MUDr. Kala Zdeněk, CSc. ¹; MUDr. Zatloukal Martin ¹; MUDr. Čan Vladimír ¹; MUDr. Hemmelová Beáta ¹; MUDr. Ostřížková Lenka ²; Bohatá Šárka ³; prof. RNDr. Slabý Ondřej, Ph.D. ^4,5; prof. MUDr. Svoboda Marek, Ph.D. ⁶; prof. MUDr. Šlampa Pavel, CSc. ⁷
Authors place of work: Chirurgická klinika LF MU a FN Brno ¹; Interní a hematoonkologická klinika LF MU a FN Brno ²; Klinika radiologie a nukleární medicíny LF MU a FN Brno ³; Ústav patologie LF MU a FN Brno ⁴; Klinika komplexní onkologické péče MOÚ Brno ⁵; Klinika radiační onkologie MOÚ Brno ⁶
Published in the journal: Klin Onkol 2020; 33(5): 362-371
Category: Review
doi: https://doi.org/10.14735/amko2020362

Summary

Background: Rectal cancer treatment advanced rapidly during last decades. The most important factors of this progress are new neoadjuvant therapy options, improvement in imaging (allowing for quality staging and restaging) and routine implementation of the total mesorectal excision technique. For the best outcomes, it is crucial to combine the treatment methods in the best way possible with ideal timing. It is necessary to keep in mind both advantages and complications of the individual kinds of approach. Therefore, interdisciplinary agreement is essential in the treatment of rectal cancer. Considering these new therapeutic possibilities, the debate about timing, indication and radicality of the surgical procedures is reopened. Surgical approaches are currently focused on mini-invasive methods and robotic surgery. New trend with promising potential seems to be clinical complete response achievement with watch and wait follow-up strategy. This approach, in the spirit of the organ sparing philosophy, however asks new questions about indication, timing and conception of this method. Proper answers are essential for sparing, yet radical oncotherapy of this disease.

Keywords:

rectal cancer – Surgical oncology – neoadjuvant therapy – organ sparing treatment – time management

Zdroje

1. Ross A, Rusnak C, Weinerman B et al. Recurrence and survival after surgical management of rectal cancer. Am J Surg 1999; 177 (5): 392–395. doi: 10.1016/s0002-9610 (99) 00080-x.

2. Bertolini F, Scarabelli L, Del Giovane C et al. Locally advanced rectal cancer (LARC): A 12-year experience of multimodality approach. JCO 2011; 29 (4_suppl): 607. doi: 10.1200/jco.2011.29.4_suppl.607.

3. Wang XJ, Chi P, Lin HM et al. Effects of neoadjuvant chemoradiotherapy on the rates of sphincter preserving surgery in lower rectal cancer and analysis of their prognostic factors. Zhonghua Wai Ke Za Zhi 2016; 54 (6): 419–423. doi: 10.3760/cma.j.issn.0529-5815.2016.06.005.

4. Wasserberg N, Kundel Y, Purim O et al. Sphincter preservation in distal CT2N0 rectal cancer after preoperative chemoradiotherapy. Radiat Oncol 2014; 9: 233. doi: 10.1186/s13014-014-0233-3.

5. Park IJ, Yu CS, Lim S-B et al. Is preoperative chemoradiotherapy beneficial for sphincter preservation in low-lying rectal cancer patients? Medicine (Baltimore) 2016; 95 (18): e3463. doi: 10.1097/MD.0000000000003463.

6. Ihn MH, Kim YH, Kim D-W et al. Effects of preoperative chemoradiotherapy on the likelihood of sphincter preservation surgery in locally advanced distal rectal cancer: a longitudinal study based on pelvic magnetic resonance imaging. Ann Surg Oncol 2015; 22 (7): 2159–2167. doi: 10.1245/s10434-014-4286-1.

7. Gérard J-P, Conroy T, Bonnetain F et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol 2006; 24 (28): 4620–4625. doi: 10.1200/JCO.2006.06.7629.

8. Richter I, Dvořák J, Bartoš J et al. Aktuální možnosti chemoradioterapie lokálně pokročilého karcinomu rekta. Onkologie 2015; 9 (6): 282–286.

9. Wiltink LM, Chen TYT, Nout RA et al. Health-related quality of life 14 years after preoperative short-term radiotherapy and total mesorectal excision for rectal cancer: report of a multicenter randomised trial. Eur J Cancer 2014; 50 (14): 2390–2398. doi: 10.1016/j.ejca.2014.06.020.

10. Rouanet P, Rullier E, Lelong B et al. Tailored treatment strategy for locally advanced rectal carcinoma based on the tumor response to induction chemotherapy: preliminary results of the French phase II multicenter GRECCAR4 trial. Dis Colon Rectum 2017; 60 (7): 653–663. doi: 10.1097/DCR.0000000000000849.

11. Bachet JB, Lucidarme O, Levache CB et al. FOLFIRINOX as induction treatment in rectal cancer patients with synchronous metastases: results of the FFCD 1102 phase II trial. Eur J Cancer 2018; 104: 108–116. doi: 10.1016/j.ejca.2018.09.006

12. Bujko K, Nowacki MP, Nasierowska-Guttmejer A et al. Sphincter preservation following preoperative radiotherapy for rectal cancer: report of a randomised trial comparing short-term radiotherapy vs. conventionally fractionated radiochemotherapy. Radiother Oncol 2004; 72 (1): 15–24. doi: 10.1016/j.radonc.2003.12.006.

13. Kulu Y, Ulrich A, Büchler MW. Resectable rectal cancer: which patient does not need preoperative radiotherapy? Dig Dis 2012; 30 Suppl 2: 118–125. doi: 10.1159/000342040.

14. Glynne-Jones R, Wyrwicz L, Tiret E et al. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018; 29 (Suppl 4): iv263. doi: 10.1093/annonc/mdy161.

15. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? BJS 1982; 69 (10): 613–616. doi: 10.1002/bjs.1800691019.

16. MacFarlane JK, Ryall RDH, Heald RJ. Mesorectal excision for rectal cancer. Lancet 1993; 341 (8843): 457–460. doi: 10.1016/0140-6736 (93) 90207-W.

17. Archampong D, Borowski D, Wille-Jørgensen P et al. Workload and surgeon’s specialty for outcome after colorectal cancer surgery. Cochrane Database Syst Rev 2012; (3): CD005391. doi: 10.1002/14651858.CD005391.pub3.

18. Nagtegaal ID, Quirke P. What is the role for the circumferential margin in the modern treatment of rectal cancer? JCO 2008; 26 (2): 303–312. doi: 10.1200/JCO.2007.12.7027.

19. MERCURY Study Group. Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. BMJ 2006; 333 (7572): 779. doi: 10.1136/bmj.38937.646400.55.

20. Chand M, Swift RI, Tekkis PP et al. Extramural venous invasion is a potential imaging predictive biomarker of neoadjuvant treatment in rectal cancer. Br J Cancer 2014; 110 (1): 19–25. doi: 10.1038/bjc.2013.603.

21. Battersby NJ, Dattani M, Rao S et al. A rectal cancer feasibility study with an embedded phase III trial design assessing magnetic resonance tumour regression grade (mrTRG) as a novel biomarker to stratify management by good and poor response to chemoradiotherapy (TRIGGER): study protocol for a randomised controlled trial. Trials 2017; 18 (1): 394. doi: 10.1186/s13063-017-2085-2.

22. Paspulati RM, Partovi S, Herrmann KA et al. Comparison of hybrid FDG PET/MRI compared with PET/CT in colorectal cancer staging and restaging: a pilot study. Abdom Imaging 2015; 40 (6): 1415–1425. doi: 10.1007/s00261-015-0474-0.

23. Balyasnikova S, Brown G. Optimal imaging strategies for rectal cancer staging and ongoing management. Curr Treat Options Oncol 2016; 17 (6): 32. doi: 10.1007/s11864-016-0403-7.

24. Macháčková T, Grolich T, Fiala L et al. Využití sekvenování nové generace v analýze cirkulujících mikroRNA jako prediktivních biomarkerů u pacientů s lokálně pokročilým karcinomem rekta. Klin Onkol 2019; 32 (Suppl 1): 157–159.

25. Svoboda M, Slyskova J, Schneiderova M et al. HOTAIR long non-coding RNA is a negative prognostic factor not only in primary tumors, but also in the blood of colorectal cancer patients. Carcinogenesis 2014; 35 (7): 1510–1515. doi: 10.1093/carcin/bgu055.

26. Khakoo S, Georgiou A, Gerlinger M et al. Circulating tumour DNA, a promising biomarker for the management of colorectal cancer. Crit Rev Oncol Hematol 2018; 122: 72–82. doi: 10.1016/j.critrevonc.2017.12.002.

27. Petit J, Carroll G, Gould T et al. Cell-free DNA as a diag-nostic blood-based biomarker for colorectal cancer: a systematic review. J Surg Res 2019; 236: 184–197. doi: 10.1016/j.jss.2018.11.029.

28. Schiffmann L, Wedermann N, Gock M et al. Intensified neoadjuvant radiochemotherapy for rectal cancer enhances surgical complications. BMC Surg 2013; 13: 43. doi: 10.1186/1471-2482-13-43.

29. Kala Z, Procházka V, Grolich T et al. Moderní trendy v chirurgii kolorektálního karcinomu aneb co by měl onkolog vědět o práci chirurga. Onkologie 2017; 11 (2): 54–60. doi: 10.36290/xon.2017.012.

30. Arjona-Sánchez A, Barrios P, Boldo-Roda E et al. HIPECT4: multicentre, randomized clinical trial to evaluate safety and efficacy of hyperthermic intra-peritoneal chemotherapy (HIPEC) with mitomycin C used during surgery for treatment of locally advanced colorectal carcinoma. BMC Cancer 2018; 18 (1): 183. doi: 10.1186/s12885-018-4096-0.

31. van der Paardt MP, Zagers MB, Beets-Tan RG et al. Patients who undergo preoperative chemoradiotherapy for locally advanced rectal cancer restaged by using diagnostic MR imaging: a systematic review and meta-analysis. Radiology 2013; 269 (1): 101–112. doi: 10.1148/radiol.13122833.

32. Carlsen E, Schlichting E, Guldvog I et al. Effect of the introduction of total mesorectal excision for the treatment of rectal cancer. Br J Surg 1998; 85 (4): 526–529. doi: 10.1046/j.1365-2168.1998.00601.x.

33. Eriksen MT, Wibe A, Norstein J et al. Anastomotic leakage following routine mesorectal excision for rectal cancer in a national cohort of patients. Colorectal Dis 2005; 7 (1): 51–57. doi: 10.1111/j.1463-1318.2004.00700.x.

34. Karanjia ND, Corder AP, Bearn P et al. Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum. Br J Surg 1994; 81 (8): 1224–1226. doi: 10.1002/bjs.1800810850.

35. Ma T, Zhong Q, Cao W et al. Clinical anastomotic leakage after rectal cancer resection can be predicted by pelvic anatomic features on preoperative MRI scans: a secondary analysis of a randomized controlled trial. Dis Colon Rectum 2019; 62 (11): 1326–1335. doi: 10.1097/DCR.0000000000001481.

36. Bertelsen CA, Andreasen AH, Jørgensen T et al. Anastomotic leakage after anterior resection for rectal cancer: risk factors. Colorectal Dis 2010; 12 (1): 37–43. doi: 10.1111/j.1463-1318.2008.01711.x.

37. Nascimbeni R, Burgart LJ, Nivatvongs S et al. Risk of lymph node metastasis in T1 carcinoma of the colon and rectum. Dis Colon Rectum 2002; 45 (2): 200–206. doi: 10.1007/s10350-004-6147-7.

38. Pachler J, Wille-Jørgensen P. Quality of life after rectal resection for cancer, with or without permanent colostomy. Cochrane Database Sys Rev 2004; (3): CD004323. doi: 10.1002/14651858.CD004323.pub4.

39. Sauer R, Liersch T, Merkel S et al. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol 2012; 30 (16): 1926–1933. doi: 10.1200/JCO.2011.40.1836.

40. Maas M, Nelemans PJ, Valentini V et al. Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data. Lancet Oncol 2010; 11 (9): 835–844. doi: 10.1016/S1470-2045 (10) 70172-8.

41. Martin ST, Heneghan HM, Winter DC. Systematic review and meta-analysis of outcomes following pathological complete response to neoadjuvant chemoradiotherapy for rectal cancer. Br J Surg 2012; 99 (7): 918–928. doi: 10.1002/bjs.8702.

42. Habr-Gama A, Perez RO, Nadalin W et al. Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results. Ann Surg 2004; 240 (4): 711–718. doi: 10.1097/01.sla.0000141194.27992.32.

43. Verseveld M, de Graaf EJR, Verhoef C et al. Chemoradiation therapy for rectal cancer in the distal rectum followed by organ-sparing transanal endoscopic microsurgery (CARTS study). Br J Surg 2015; 102 (7): 853–860. doi: 10.1002/bjs.9809.

44. Duchalais E, Glyn Mullaney T, Spears GM et al. Prognostic value of pathological node status after neoadjuvant radiotherapy for rectal cancer. Br J Surg 2018; 105 (11): 1501–1509. doi: 10.1002/bjs.10867.

45. Kong JC, Guerra GR, Warrier SK et al. Outcome and salvage surgery following ‘watch and wait’ for rectal cancer after neoadjuvant therapy: a systematic review. Dis Colon Rectum 2017; 60 (3): 335–345. doi: 10.1097/DCR.0000000000000754.

46. Dossa F, Chesney TR, Acuna SA et al. A watch-and-wait approach for locally advanced rectal cancer after a clinical complete response following neoadjuvant chemoradiation: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2017; 2 (7): 501–513. doi: 10.1016/S2468-1253 (17) 30074-2.

47. Rullier E, Rouanet P, Tuech J-J et al. Organ preservation for rectal cancer (GRECCAR 2): a prospective, randomised, open-label, multicentre, phase 3 trial. Lancet 2017; 390 (10093): 469–479. doi: 10.1016/S0140-6736 (17) 31056-5.

48. Verseveld M, de Graaf EJ, Verhoef C et al. Chemoradiation therapy for rectal cancer in the distal rectum followed by organ-sparing transanal endoscopic microsurgery (CARTS study). Br J Surg 2015; 102 (7): 853–860. doi: 10.1002/bjs.9809.

49. Stijns RC, de Graaf EJ, Punt CJ et al. Long-term oncological and functional outcomes of chemoradiotherapy followed by organ-sparing transanal endoscopic microsurgery for distal rectal cancer: the CARTS study. JAMA Surg 2019; 154 (1): 47–54. doi: 10.1001/jamasurg.2018.3752.