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Reduced pelvic field sparing anastomosis for postoperative radiotherapy in selected patients with mid–upper rectal cancer

The aim of this study was to report the clinical results of reduced pelvic field radiotherapy (RT), excluding the anastomotic site, after total mesorectal excision in selected patients with rectal cancer. Between 2011 and 2014, 99 patients underwent upfront surgery for clinically less-advanced tumor...

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Autores principales: Choi, Seo Hee, Chang, Jee Suk, Kim, Nam Kyu, Lim, Joon Seok, Min, Byung So, Hur, Hyuk, Shin, Sang Joon, Ahn, Joong Bae, Kim, Yong Bae, Koom, Woong Sub
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5569916/
https://www.ncbi.nlm.nih.gov/pubmed/28122969
http://dx.doi.org/10.1093/jrr/rrw127
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author Choi, Seo Hee
Chang, Jee Suk
Kim, Nam Kyu
Lim, Joon Seok
Min, Byung So
Hur, Hyuk
Shin, Sang Joon
Ahn, Joong Bae
Kim, Yong Bae
Koom, Woong Sub
author_facet Choi, Seo Hee
Chang, Jee Suk
Kim, Nam Kyu
Lim, Joon Seok
Min, Byung So
Hur, Hyuk
Shin, Sang Joon
Ahn, Joong Bae
Kim, Yong Bae
Koom, Woong Sub
author_sort Choi, Seo Hee
collection PubMed
description The aim of this study was to report the clinical results of reduced pelvic field radiotherapy (RT), excluding the anastomotic site, after total mesorectal excision in selected patients with rectal cancer. Between 2011 and 2014, 99 patients underwent upfront surgery for clinically less-advanced tumors but were finally diagnosed as pT3/N+. Among them, 50 patients with mid–upper rectal cancer who received postoperative RT with a reduced pelvic field were included in this retrospective review. This group was composed of patients with high seated tumors, complete resection with a clear circumferential resection margin, and no complication during surgery. We investigated treatment outcomes, toxicity and the effect of RT-field reduction on organs-at risk in 5 randomly selected patients. During the median follow-up period of 42 months (range: 15−59 months), tumors recurred in 9 patients (18%). The 3-year overall and disease-free survival were 98% and 81%, respectively. Distant metastasis was the dominant failure pattern (n = 8, 16%), while no recurrences occurred at or near anastomotic sites. No anastomotic complications were found on pelvic examination, images and/or colonoscopy. Reported acute and late RT-related toxicities were mostly mild to moderate, with only small numbers of Grade 3 toxicities. None of the patients developed Grade 4−5 acute or late toxicity. With a caudally reduced field, 64% reduction in absolute anastomotic exposure at the maximum dose was achieved compared with the traditional whole-pelvic field (P = 0.008). The reduced pelvic field RT was able to minimize late anastomotic complication without increasing its recurrence in selected patients with mid–upper rectal cancer in the postoperative setting.
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spelling pubmed-55699162017-08-29 Reduced pelvic field sparing anastomosis for postoperative radiotherapy in selected patients with mid–upper rectal cancer Choi, Seo Hee Chang, Jee Suk Kim, Nam Kyu Lim, Joon Seok Min, Byung So Hur, Hyuk Shin, Sang Joon Ahn, Joong Bae Kim, Yong Bae Koom, Woong Sub J Radiat Res Oncology The aim of this study was to report the clinical results of reduced pelvic field radiotherapy (RT), excluding the anastomotic site, after total mesorectal excision in selected patients with rectal cancer. Between 2011 and 2014, 99 patients underwent upfront surgery for clinically less-advanced tumors but were finally diagnosed as pT3/N+. Among them, 50 patients with mid–upper rectal cancer who received postoperative RT with a reduced pelvic field were included in this retrospective review. This group was composed of patients with high seated tumors, complete resection with a clear circumferential resection margin, and no complication during surgery. We investigated treatment outcomes, toxicity and the effect of RT-field reduction on organs-at risk in 5 randomly selected patients. During the median follow-up period of 42 months (range: 15−59 months), tumors recurred in 9 patients (18%). The 3-year overall and disease-free survival were 98% and 81%, respectively. Distant metastasis was the dominant failure pattern (n = 8, 16%), while no recurrences occurred at or near anastomotic sites. No anastomotic complications were found on pelvic examination, images and/or colonoscopy. Reported acute and late RT-related toxicities were mostly mild to moderate, with only small numbers of Grade 3 toxicities. None of the patients developed Grade 4−5 acute or late toxicity. With a caudally reduced field, 64% reduction in absolute anastomotic exposure at the maximum dose was achieved compared with the traditional whole-pelvic field (P = 0.008). The reduced pelvic field RT was able to minimize late anastomotic complication without increasing its recurrence in selected patients with mid–upper rectal cancer in the postoperative setting. Oxford University Press 2017-07 2017-01-25 /pmc/articles/PMC5569916/ /pubmed/28122969 http://dx.doi.org/10.1093/jrr/rrw127 Text en © The Author 2017. Published by Oxford University Press on behalf of The Japan Radiation Research Society and Japanese Society for Radiation Oncology. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Oncology
Choi, Seo Hee
Chang, Jee Suk
Kim, Nam Kyu
Lim, Joon Seok
Min, Byung So
Hur, Hyuk
Shin, Sang Joon
Ahn, Joong Bae
Kim, Yong Bae
Koom, Woong Sub
Reduced pelvic field sparing anastomosis for postoperative radiotherapy in selected patients with mid–upper rectal cancer
title Reduced pelvic field sparing anastomosis for postoperative radiotherapy in selected patients with mid–upper rectal cancer
title_full Reduced pelvic field sparing anastomosis for postoperative radiotherapy in selected patients with mid–upper rectal cancer
title_fullStr Reduced pelvic field sparing anastomosis for postoperative radiotherapy in selected patients with mid–upper rectal cancer
title_full_unstemmed Reduced pelvic field sparing anastomosis for postoperative radiotherapy in selected patients with mid–upper rectal cancer
title_short Reduced pelvic field sparing anastomosis for postoperative radiotherapy in selected patients with mid–upper rectal cancer
title_sort reduced pelvic field sparing anastomosis for postoperative radiotherapy in selected patients with mid–upper rectal cancer
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5569916/
https://www.ncbi.nlm.nih.gov/pubmed/28122969
http://dx.doi.org/10.1093/jrr/rrw127
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