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Review
. 2023 Apr 6;3(4):548-557.
doi: 10.1158/2767-9764.CRC-22-0385. eCollection 2023 Apr.

Treatment Patterns and Outcomes of Preoperative Neoadjuvant Radiotherapy in Patients with Early-onset Rectal Cancer

Jasleen K Badesha  1   2 , Marilyn Zhou  1 , Arif A Arif  1   2 , Sharlene Gill  1   2 , Caroline Speers  1 , Michael Peacock  1   2 , Mary A De Vera  2 , Heather C Stuart  2   3 , Carl J Brown  2   4 , Fergal Donellan  2   3 , Jonathan M Loree  1   2
Affiliations
Review

Treatment Patterns and Outcomes of Preoperative Neoadjuvant Radiotherapy in Patients with Early-onset Rectal Cancer

Jasleen K Badesha et al. Cancer Res Commun. .

Abstract

Preoperative radiotherapy for early-stage rectal cancer has risks and benefits that may impact treatment choice in young patients. We reviewed radiotherapy use and outcomes for rectal cancer by age. Patients with early-stage rectal cancer in the Canadian province of British Columbia from 2002 to 2016 were identified (n = 6,232). Baseline characteristics, treatment response, overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS), and locoregional recurrence rate (LRR) were compared between patients <50 (early-onset; n = 532) and ≥50 years old (average-onset; n = 5,700). Early-onset patients were more likely to receive preoperative chemoradiotherapy than short-course radiotherapy [OR, 2.20; 95% confidence interval (CI), 1.67-2.89; P < 0.0001], but also had higher nodal (P = 0.00096) and overall clinical staging (P = 0.033). Cancer downstaging and pathologic complete response rates were similar in those receiving neoadjuvant chemoradiotherapy by age. Early-onset and average-onset patients had similar DSS (P = 0.91) and DFS (P = 0.27) in multivariate analysis unless non-colorectal deaths, which were higher in older patients, were censored in the DFS model (HR, 1.30; 95% CI, 1.01-1.68; P = 0.042). LRR also did not differ between age groups (P = 0.88). Outcomes did not differ based on radiotherapy type. Young patients with rectal cancer are more likely to present with higher staging and receive long-course chemoradiotherapy. DSS did not differ by age group; however, young patients had worse DFS when we censored competing risks of death in older patients.

Significance: This population-based study suggests younger patients are more likely to receive chemoradiotherapy, potentially due to higher stage at diagnosis, and response is comparable by age.

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Figures

FIGURE 1
FIGURE 1
Stage distribution of early-stage rectal cancers in early-onset and average-onset patients (A) and stage distribution of early-stage rectal cancers in early-onset decile age groups and average-onset patients (B).
FIGURE 2
FIGURE 2
Treatment patterns of early-stage rectal cancer (A), overall stage downstaging (B), and pCR rates in those who received long-course neoadjuvant chemoradiotherapy (C).
FIGURE 3
FIGURE 3
OS (A), DSS (B), DFS (C), and DSDFS (D) based on age group in early-stage rectal cancers.
See this image and copyright information in PMC

References

    1. Siegel RL, Torre LA, Soerjomataram I, Hayes RB, Bray F, Weber TK, et al. . Global patterns and trends in colorectal cancer incidence in young adults. Gut. 2019;68:2179–85. - PubMed
    1. Willauer AN, Liu Y, Pereira AAL, Lam M, Morris JS, Raghav KPS, et al. . Clinical and molecular characterization of early-onset colorectal cancer. Cancer. 2019;125:2002–10. - PMC - PubMed
    1. Cammà C, Giunta M, Fiorica F, Pagliaro L, Craxì A, Cottone M. Preoperative radiotherapy for resectable rectal cancer: a meta-analysis. JAMA 2000;284:1008–15. - PubMed
    1. Swedish Rectal Cancer Trial, Cedermark B, Dahlberg M, Glimelius B, Påhlman L, Rutqvist LE, et al. . Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med 1997;336:980–7. - PubMed
    1. Kapiteijn E, Marijnen CAM, Nagtegaal ID, Putter H, Steup WH, Wiggers T, et al. . Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001;345:638–46. - PubMed

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