Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Mar;17(1):e129-e142.
doi: 10.1016/j.clcc.2017.09.002. Epub 2017 Sep 28.

Neoadjuvant Therapy in Rectal Cancer Patients With Clinical Stage II to III Across European Countries: Variations and Outcomes

Masoud Babaei  1 , Lina Jansen  1 , Yesilda Balavarca  2 , Annika Sjövall  3 , Amanda Bos  4 , Tony van de Velde  5 , Michel Moreau  6 , Gabriel Liberale  6 , Ana Filipa Gonçalves  7 , Maria José Bento  7 , Cornelia M Ulrich  8 , Petra Schrotz-King  2 , Valery Lemmens  4 , Bengt Glimelius  9 , Hermann Brenner  10
Affiliations

Neoadjuvant Therapy in Rectal Cancer Patients With Clinical Stage II to III Across European Countries: Variations and Outcomes

Masoud Babaei et al. Clin Colorectal Cancer. 2018 Mar.

Abstract

Background: Neoadjuvant therapy improves survival of patients with clinical stage II and III rectal cancer in clinical trials. In this study, we investigated the administration of neoadjuvant radiotherapy (neo-RT) and neoadjuvant chemoradiotherapy (neo-CRT) and its association with survival in resected patients in 2 European countries (The Netherlands and Sweden) and at 3 specialist centers.

Materials and methods: Administration of neoadjuvant treatment (all registries) and overall survival after surgery in The Netherlands and Sweden were assessed. Hazard ratios (HRs) were obtained using Cox regression adjusted for potential confounders.

Results: A total of 16,095 rectal cancer patients with clinical stage II and III were eligible for analyses. Large variations in administration of neo-RT and neo-CRT were observed. Elderly patients less often received neo-RT and neo-CRT. Patients with stage III disease received neo-CRT more frequently than neo-RT. Administration of neo-RT versus surgery without neoadjuvant treatment was significantly associated with improved survival in The Netherlands (HR, 0.62; 95% confidence interval [CI], 0.53-0.73) as well as in Sweden (HR, 0.79; 95% CI, 0.69-0.90). Administration of neo-CRT was associated with enhanced survival in The Netherlands (HR, 0.62; 95% CI, 0.50-0.78) but not in Sweden (HR, 0.97; 95% CI, 0.80-1.18). The mortality of patients treated with neo-CRT compared with neo-RT showed inconsistent results in population-based centers.

Conclusions: Our results support an association of neo-RT with enhanced survival among stage II and III rectal cancer patients. Comparing neo-CRT with neo-RT, larger variations and inconsistent results with respect to survival were observed across centers.

Keywords: Long-term outcomes; Neoadjuvant therapy; Rectal cancer; Survival; Variations.

PubMed Disclaimer

Conflict of interest statement

Disclosure

The authors have stated that they have no conflicts of interest.

Figures

Figure 1
Figure 1. Flow Chart of the Inclusion of Rectal Cancer Patients According to Participating Center
Abbreviations: IJB = Institute Jules Bordet in Brussels; IPO-PORTO = Portuguese Oncology Institute of Porto; NCR = Netherlands Cancer Registry; Neo-CRT = neoadjuvant chemoradiation; Neo-RT = neoadjuvant radiotherapy; NKI = Netherlands Cancer Institute in Amsterdam; SCRCR = Swedish ColoRectal Cancer Registry.
Figure 2
Figure 2. The Age-Standardized Trend of Administration of Neoadjuvant Therapy Between 2007 and 2014
Abbreviations: IJB = Institute Jules Bordet in Brussels; IPO-PORTO = Portuguese Oncology Institute of Porto; NCR = Netherlands Cancer Registry; neo-CRT = neoadjuvant chemoradiation; neo-RT = neoadjuvant radiotherapy; NKI = Netherlands Cancer Institute in Amsterdam; no neoadj. = no neoadjuvant therapy; SCRCR = Swedish ColoRectal Cancer Registry.
Figure 3
Figure 3
Survival of Patients in The Netherlands and Sweden According to the Administration of (A) and (B) Neoadjuvant Radiotherapy (Neo-RT) or (C) and (D) Neoadjuvant Chemoradiation (Neo-CRT) and (E) and (F) Either Neo-RT or Neo-CRT Obtained From Cox Regression Models With Adjustment for Sex, Age Group, Tumor Stage, and Administration of Adjuvant Therapy
See this image and copyright information in PMC

References

    1. Benson AB, Venook AP, Bekaii-Saab T, et al. Rectal cancer, version 2, 2015. J Natl Compr Canc Netw. 2015;13:719–28. - PubMed
    1. Maringe C, Walters S, Rachet B, et al. Stage at diagnosis and colorectal cancer survival in six high-income countries: a population-based study of patients diagnosed during 2000–2007. Acta Oncol. 2013;52:919–32. - PubMed
    1. Schmoll HJ, Van Cutsem E, Stein A, et al. ESMO consensus guidelines for management of patients with colon and rectal cancer. A personalized approach to clinical decision-making. Ann Oncol. 2012;23:2479–516. - PubMed
    1. Glimelius B, Tiret E, Cervantes A, et al. Rectal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24(suppl 6):vi81–8. - PubMed
    1. Poston GJ, Tait D, O’Connell S, et al. Diagnosis and management of colorectal cancer: summary of NICE guidance. BMJ. 2011;343:d6751. - PubMed

Publication types