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. 2022 Feb;198(2):201-208.
doi: 10.1007/s00066-021-01878-y. Epub 2021 Nov 25.

Neoadjuvant chemoradiotherapy for locally advanced rectal cancer with peritumoral abscesses and fistulas

Sergey Gordeyev  1 , Valerii Ivanov  2 , Mikhail Fedianin  3   4 , Marina Chernikh  3   2   5 , Nikolay Kozlov  3 , Leonid Petrov  6 , Dmitriy Erygin  7 , Ivan Gridasov  8 , Valery Kaushanskiy  9 , Dmitry Feoktistov  10 , Zaman Mamedli  3
Affiliations

Neoadjuvant chemoradiotherapy for locally advanced rectal cancer with peritumoral abscesses and fistulas

Sergey Gordeyev et al. Strahlenther Onkol. 2022 Feb.

Abstract

Purpose: Rectal cancer patients who present with peritumoral abscesses and fistulas at the time of diagnosis may be denied chemoradiotherapy (CRT) as the safety is unknown. The aim of this study was to investigate the safety of preoperative CRT in this patient group.

Methods: We performed a retrospective nested case-control study to compare outcomes between patients with locally advanced rectal cancer with peritumoral abscesses and fistulas (study group) and patients with T4 locally advanced rectal cancer with no evidence of abscesses and fistulas (control group). These groups were matched by treatment center and radiotherapy delivery method. All patients received 50-54 Gy of conventionally fractionated RT with concurrent chemotherapy. Primary endpoint was grade 3-5 toxicity (by National Cancer Institute Common Toxicity Criteria for Adverse Events (NCI CTCAE). Secondary endpoints included postoperative morbidity, pathologic complete response (pCR), disease-free survival (DFS), and overall survival (OS) at 2 years.

Results: A total of 33 patients were included in each group. Grade 3 toxicity was observed in 2 (6.1%) patients in the study group and 4 (12.1%) patients in the control group (p = 0.672). No patients developed grade 4-5 toxicity. Grade 3-4 Clavien-Dindo complications were observed in 5 (15.2%) patients in the study group and in 6 (18.2%) patients in the control group (p = 1.0). Pathologic CR was achieved in 3 (9.1%) and 5 (15.2%) patients, respectively (p = 0.708). Two-year OS was 78.3% vs. 81.8% (p = 0.944), 2‑year DFS was 62.8% vs. 69.7% (p = 0.693), respectively.

Conclusion: The presence of peritumoral abscesses and fistulas in patients with locally advanced rectal cancer is not associated with increased toxicity or inferior clinical outcomes after preoperative CRT.

Keywords: Perianal fistula; Rectal cancer with abscess; Rectovaginal fistula; Rectovesical fistula; Tumor-associated fistula.

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References

    1. Cameron MG, Kersten C, Vistad I, van Helvoirt R, Weyde K, Undseth C, Mjaaland I, Skovlund E, Fossa SD, Guren MG (2016) Palliative pelvic radiotherapy for symptomatic rectal cancer—a prospective multicenter study. Acta Oncol 55(12):1400–1407. https://doi.org/10.1080/0284186X.2016.1191666 - DOI - PubMed
    1. Bacalbasa N, Bãlescu I (2015) Total pelvic exenteration for locally invasive cervical cancer with vesico-vaginal fistula. Mod Med 22(1):73–77
    1. Matsumoto T, Nakanishi M, Miyamae M, Takao K, Fukunaga T, Otsuji E (2017) A case of locally advanced rectal cancer with abscess and rectovesical fistula curatively resected following preoperative chemotherapy. Gan To Kagaku Ryoho 44(12):1482–1484 - PubMed
    1. el Benjelloun B, Aitalalim S, Chbani L, Mellouki I, Mazaz K, Aittaleb K (2012) Rectosigmoid adenocarcinoma revealed by metastatic anal fistula. The visible part of the iceberg: a report of two cases with literature review. World J Surg Oncol 10:209. https://doi.org/10.1186/1477-7819-10-209 - DOI - PMC
    1. Kitahara T, Uemura M, Haraguchi N, Nishimura J, Shingai T, Hata T, Takemasa I, Mizushima T, Doki Y, Mori M, Yamamoto H (2014) Successful treatment of rectal cancer with perineal invasion: three case reports. mol clin onc 2(4):497–500. https://doi.org/10.3892/mco.2014.282 - DOI

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