26: Neoadjuvant Chemoradiation Does Not Improve Outcomes for Patients Undergoing Resection for Upper Rectal Cancer: A US Rectal Cancer Consortium Analysis

Thursday, March 23, 2023

11:06 AM – 11:16 AM

Location: Ballroom C

Abstract Presenter(s)

Caroline Medin, MD (she/her/hers)

Resident
Emory University, United States

Disclosure(s): No financial relationships to disclose

First Author(s)

Caroline Medin, MD (she/her/hers)

Resident
Emory University, United States

Disclosure(s): No financial relationships to disclose

Author(s)

AG

Adriana C. Gamboa, MD

Resident
Emory University, United States

Disclosure information not submitted.
EW

Emilie K. Warren, MD

Research Fellow
Winship Cancer Institute, Emory University, United States

Disclosure information not submitted.
SR

Scott E. Regenbogen, MD, MPH

Professor of Surgery
University of Michigan, United States

Disclosure information not submitted.
SH

Samantha K. Hendren, MD

Associate Professor
University of Michigan, United States

Disclosure information not submitted.
JH

Jennifer M. Holder-Murray, MD

Associate Professor of Surgery
University of Pittsburgh Medical Center, United States

Disclosure information not submitted.
Matthew Kalady, MD (he/him/his)

Professor of Surgery, Chief, Division of Colon and Rectal Surgery
The Ohio State University and James Comprehensive Cancer Center

Disclosure(s): Activ: Advisor (Ongoing), Consultant (Ongoing), Speaker (Ongoing)
Aslam Ejaz, MD, MPH

Assistant Professor of Surgery
The Ohio State University

Disclosure information not submitted.
AH

Alexander T. Hawkins, MD, MPH

Associate Professor of Surgery
Vanderbilt University Medical Center, United States

Disclosure information not submitted.
MS

Matthew L. Silviera, MD

Assistant Professor of Surgery
Washington University School of Medicine in St. Louis, United States

Disclosure information not submitted.
Shishir K. Maithel, MD

Professor of Surgery
Emory
Atlanta, GA, United States

Disclosure information not submitted.
GB

Glen C. Balch, MD, MBA

Professor of Surgery
Winship Cancer Institute, Emory University, United States

Disclosure information not submitted.

Disclosure(s):

Caroline Medin, MD: No financial relationships to disclose

Matthew Kalady, MD: Activ: Advisor (Ongoing), Consultant (Ongoing), Speaker (Ongoing)

Introduction: The use of neoadjuvant chemoradiation (NCRT) for upper rectal cancer remains controversial. Our aim was to determine whether NCRT was associated with improved outcomes.

Methods: The US Rectal Cancer Consortium was queried for patients who underwent resection of non-metastatic upper rectal cancer (≥12cm from anal verge) from 2007-2017. Primary outcomes were recurrence-free (RFS) and overall survival (OS). Secondary outcomes were postoperative complications.

Results: 193 patients met inclusion criteria; 100 (52%) did not receive NCRT and 93 (48%) did. Median age was similar between groups (non-NCRT: 62 years; NCRT: 57 years; p=0.71). Patients in each group had similar gender and stage (non-NCRT: 22% stage I, 32% stage II, 36% stage III; NCRT: 21% stage I, 23% stage II, 33% stage III; p=0.143). Median follow-up was 31 months (non-NCRT) and 34 months (NCRT). On Kaplan-Meier analysis, NCRT was not associated with improved RFS compared to non-NCRT (3-year RFS 85% vs. 80%; p=0.34) or OS (3-year OS 88% vs. 90%; p=0.49; Figure 1). This finding persisted on multivariable cox regression. R0 resection rate was similar between groups at 99% (non-NCRT) and 97% (NCRT; p=0.27). Anastomotic leak occurred in 11% of both cohorts. Creation of a diverting loop ileostomy (DLI) was nearly 3 times higher in NCRT (82%) versus non-NCRT patients (29%; p< 0.001).

Conclusions: Among patients with non-metastatic upper rectal cancer, NCRT did not improve survival or recurrence rates, but was associated with a nearly threefold higher DLI rate. Although NCRT is a mainstay of treatment for lower rectal cancer, our results do not support its use in upper rectal cancer.

Learning Objectives:

Upon completion, participant will be able to describe the survival benefit to neoadjuvant chemoradiation for upper rectal cancer.
Upon completion, participants will be able to describe the association between neodadjuvant chemoradiation and postoperative complications for upper rectal cancer patients.
Upon completion, participant will be able to describe the incidence of diverting loop ileostomy creation following neoadjuvant chemoradiation for upper rectal cancer.