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Excluding the ischiorectal fossa irradiation during neoadjuvant chemoradiotherapy with intensity-modulated radiotherapy followed by abdominoperineal resection decreases perineal complications in patients with lower rectal cancer

BACKGROUND: The aim of this study was to explore the impact of including or excluding the ischiorectal fossa (IRF) within the clinical target volume during neoadjuvant chemoradiotherapy (NCRT) using intensity modulated radiotherapy, in locally advanced lower rectal cancer (LALRC). METHODS: We retros...

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Autores principales: Song, Maxiaowei, Geng, Jianhao, Wang, Lin, Li, Yongheng, Zhu, Xianggao, Li, Xiaofan, Mi, Lan, Wu, Aiwen, Peng, Yifan, Yao, Yunfeng, Zhang, Yangzi, Wang, Hongzhi, Shi, Chen, Cai, Yong, Wang, Weihu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683419/
https://www.ncbi.nlm.nih.gov/pubmed/31382984
http://dx.doi.org/10.1186/s13014-019-1338-5
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author Song, Maxiaowei
Geng, Jianhao
Wang, Lin
Li, Yongheng
Zhu, Xianggao
Li, Xiaofan
Mi, Lan
Wu, Aiwen
Peng, Yifan
Yao, Yunfeng
Zhang, Yangzi
Wang, Hongzhi
Shi, Chen
Cai, Yong
Wang, Weihu
author_facet Song, Maxiaowei
Geng, Jianhao
Wang, Lin
Li, Yongheng
Zhu, Xianggao
Li, Xiaofan
Mi, Lan
Wu, Aiwen
Peng, Yifan
Yao, Yunfeng
Zhang, Yangzi
Wang, Hongzhi
Shi, Chen
Cai, Yong
Wang, Weihu
author_sort Song, Maxiaowei
collection PubMed
description BACKGROUND: The aim of this study was to explore the impact of including or excluding the ischiorectal fossa (IRF) within the clinical target volume during neoadjuvant chemoradiotherapy (NCRT) using intensity modulated radiotherapy, in locally advanced lower rectal cancer (LALRC). METHODS: We retrospectively analysed the data of 220 LALRC patients who received NCRT followed by abdominoperineal resection between January 2009 and January 2015. Six patients were excluded because of loss to follow-up, 90 patients received IRF irradiation (IRF group) while 124 patients did not (NIRF group). Survival, patterns of recurrence, and treatment toxicities were compared between the two groups. RESULTS: Overall, patient/treatment variables were well balanced except for surgical technique. Perineal wound complications in the IRF and NIRF groups, were 40.0 and 24.2%, respectively (p = 0.010); corresponding 3-year perineal recurrence rates, local recurrence free survival, overall survival, and distant relapse free survival were 4.4% vs. 2.4% (p = 0.670), 88.1% vs. 95.0% (p = 0.079), 82.6% vs. 88.4% (p = 0.087), and 61.9% vs. 81.0% (p = 0.026), respectively. Multivariate analyses demonstrated the following factors to be significantly related to perineal wound complications: irradiation of the IRF (odds ratio [OR] 2.892, p = 0.002), anaemia (OR 3.776, p = 0.010), operation duration > 180 min (OR 2.486, p = 0.007), and interval between radiotherapy and surgery > 8 weeks (OR 2.400, p = 0.010). CONCLUSIONS: Exclusion of the IRF from the clinical target volume during NCRT using intensity-modulated radiotherapy in LALRC could lower the incidence of perineal wound complications after abdominoperineal resection, without compromising oncological outcomes. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13014-019-1338-5) contains supplementary material, which is available to authorized users.
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spelling pubmed-66834192019-08-09 Excluding the ischiorectal fossa irradiation during neoadjuvant chemoradiotherapy with intensity-modulated radiotherapy followed by abdominoperineal resection decreases perineal complications in patients with lower rectal cancer Song, Maxiaowei Geng, Jianhao Wang, Lin Li, Yongheng Zhu, Xianggao Li, Xiaofan Mi, Lan Wu, Aiwen Peng, Yifan Yao, Yunfeng Zhang, Yangzi Wang, Hongzhi Shi, Chen Cai, Yong Wang, Weihu Radiat Oncol Research BACKGROUND: The aim of this study was to explore the impact of including or excluding the ischiorectal fossa (IRF) within the clinical target volume during neoadjuvant chemoradiotherapy (NCRT) using intensity modulated radiotherapy, in locally advanced lower rectal cancer (LALRC). METHODS: We retrospectively analysed the data of 220 LALRC patients who received NCRT followed by abdominoperineal resection between January 2009 and January 2015. Six patients were excluded because of loss to follow-up, 90 patients received IRF irradiation (IRF group) while 124 patients did not (NIRF group). Survival, patterns of recurrence, and treatment toxicities were compared between the two groups. RESULTS: Overall, patient/treatment variables were well balanced except for surgical technique. Perineal wound complications in the IRF and NIRF groups, were 40.0 and 24.2%, respectively (p = 0.010); corresponding 3-year perineal recurrence rates, local recurrence free survival, overall survival, and distant relapse free survival were 4.4% vs. 2.4% (p = 0.670), 88.1% vs. 95.0% (p = 0.079), 82.6% vs. 88.4% (p = 0.087), and 61.9% vs. 81.0% (p = 0.026), respectively. Multivariate analyses demonstrated the following factors to be significantly related to perineal wound complications: irradiation of the IRF (odds ratio [OR] 2.892, p = 0.002), anaemia (OR 3.776, p = 0.010), operation duration > 180 min (OR 2.486, p = 0.007), and interval between radiotherapy and surgery > 8 weeks (OR 2.400, p = 0.010). CONCLUSIONS: Exclusion of the IRF from the clinical target volume during NCRT using intensity-modulated radiotherapy in LALRC could lower the incidence of perineal wound complications after abdominoperineal resection, without compromising oncological outcomes. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13014-019-1338-5) contains supplementary material, which is available to authorized users. BioMed Central 2019-08-05 /pmc/articles/PMC6683419/ /pubmed/31382984 http://dx.doi.org/10.1186/s13014-019-1338-5 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Song, Maxiaowei
Geng, Jianhao
Wang, Lin
Li, Yongheng
Zhu, Xianggao
Li, Xiaofan
Mi, Lan
Wu, Aiwen
Peng, Yifan
Yao, Yunfeng
Zhang, Yangzi
Wang, Hongzhi
Shi, Chen
Cai, Yong
Wang, Weihu
Excluding the ischiorectal fossa irradiation during neoadjuvant chemoradiotherapy with intensity-modulated radiotherapy followed by abdominoperineal resection decreases perineal complications in patients with lower rectal cancer
title Excluding the ischiorectal fossa irradiation during neoadjuvant chemoradiotherapy with intensity-modulated radiotherapy followed by abdominoperineal resection decreases perineal complications in patients with lower rectal cancer
title_full Excluding the ischiorectal fossa irradiation during neoadjuvant chemoradiotherapy with intensity-modulated radiotherapy followed by abdominoperineal resection decreases perineal complications in patients with lower rectal cancer
title_fullStr Excluding the ischiorectal fossa irradiation during neoadjuvant chemoradiotherapy with intensity-modulated radiotherapy followed by abdominoperineal resection decreases perineal complications in patients with lower rectal cancer
title_full_unstemmed Excluding the ischiorectal fossa irradiation during neoadjuvant chemoradiotherapy with intensity-modulated radiotherapy followed by abdominoperineal resection decreases perineal complications in patients with lower rectal cancer
title_short Excluding the ischiorectal fossa irradiation during neoadjuvant chemoradiotherapy with intensity-modulated radiotherapy followed by abdominoperineal resection decreases perineal complications in patients with lower rectal cancer
title_sort excluding the ischiorectal fossa irradiation during neoadjuvant chemoradiotherapy with intensity-modulated radiotherapy followed by abdominoperineal resection decreases perineal complications in patients with lower rectal cancer
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683419/
https://www.ncbi.nlm.nih.gov/pubmed/31382984
http://dx.doi.org/10.1186/s13014-019-1338-5
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