The occurrence of distant metastases after long term chemoradiotherapy followed by surgical excision

Martina Lukacovicova, Andrea Hurakova, Danijela Scepanovic, Andrea Masarykova, Margita Pobijakova, Zuzana Dolinska

Department of Radiation Oncology, National Oncology Institute, Bratislava, Slovakia

Background

Approximately 50% to 60% of patients who haveundergone treatment for rectal cancer will develop

metastases. Hepatic (20%–25%), pulmonary (10%–20%), bone

(6%–10%), and brain (3%) represent the most common sites of distant disease.

Purpose

How much had the impact of total mesorectalexcision (TME) after long term

chemoradiotherapy on the reduction of distantmetastases.

Material and MethodsPatients’ characteristics

Two hundred fifty patients were enrolledbetween January 2004 and December 2010

Median age was 62 years (min=26, max=83) The ratio of men to women was 2:1 To be eligible, patients had to have

histologically confirmed adenocarcinoma of the rectum, without evidence of distant

metastases

Material and methodsInitial TNM stage

T10%

T3N+55%

T2N+4%

T45%

T324%

T24%

T4N+8%

T1T2T3T4T2N+T3N+T4N+

Material and methodsRadiotherapy

All patients hadpreoperativeradiotherapy (RT) with a total dose of 45-50.4Gy in 25-28fractions for 5 to 5.5weeks

020406080

100120140160180200

to 45Gy over 45Gy

No

Material and methodsChemotherapy

Chemotherapy (CT) wasperformed concomitantly with RT:1. 5-fluorouracil – 168 patients2. capecitabine – 72 patients3. without CT – 10 patients

0

20

40

60

80

100

120

140

160

180

5-fluorouracil capecitabine w ithout CT

No

Material and methodsSurgery

Six weeks after RT/CT patients were operated with:

1. Total mesorectal excision (TME)=118 patients2. Non total mesorectal excision (nonTME)=132

patients

ResultsDistant metastases rate

Median follow-up time = 48 months (range, 12 to 96 months).

The cumulative proportion of distant metastases was 20.4% for all group of patients (250):

TME group – 6.4%nonTME group – 14%

p=0.0121

Results Time to progression

15

24

monthsnonTMETME

min=12; max=36

min=10; max=60

ResultsThe most common sites of distant metastases

Fifty one patients had distant metastases in whole group of patients:TME group=16nonTME group=35

0

2

4

6

8

10

12

14

livermetastases

lungmetastases

liver/lung lung/bones bones

TMEnonTME

p=0.3451

p=0.3294

p=1

p=1 p=0.5810

p=0.0121

No

ResultsSurvival

• There was no statistically significant differencein survival between these two groups of patientswith distant metastases (6pts vs 12pts who werealive, p=0.8236, chi square).

• Median survival time of patients in the TMEgroup was 36 months (range, 24 to 72 months)and in the group with non TME 42 months(range, 24 to 60 months).

Results5 years DFS for whole group of patients

0

10

20

30

40

50

60

70

80

90

100

0 to 12 12 to 24 24 to 36 36 to 48 48 to 60 60 to 72 72 to 84 84 to 96

TMEnonTME

months

%

p=0.0025

Results5 years OS for whole group of patients

0

10

20

30

40

50

60

70

80

90

100

0 to 12 12 to 24 24 to 36 36 to 48 48 to 60 60 to 72 72 to 84 84 to 96

TMEnonTME

months

%

p=0.0012

Conclusion

Total mesorectal excision after long term chemoradiotherapy significantly

reduced the occurrence of distant metastases in our patients, however, without the

influence on their survival.

3-6 July 2013, Barcelona, Spain