PHILADELPHIA (November 25, 2024) — Adjuvant therapy regimens inclusive of chemotherapy were independently associated with improved survival in patients with cT2N0 rectal cancer upstaged to T3N0, according to a new study by researchers at Fox Chase Cancer Center and Temple Health.
Patients with clinical T2N0 (cT2N0) staged rectal cancer have been diagnosed with rectal cancer that has spread past the submucosa into a layer known as the muscularis propria, but the cancer has not spread to other organs or structures. Typically, these patients undergo surgical resection first and the final pathologic stage of the cancer dictates if additional treatment such as chemotherapy or radiation is needed.
In some cases, the cancer is upstaged to pathologic T3N0 following surgery. Current National Comprehensive Cancer Network (NCCN) guidelines provide numerous options for these patients, including no further treatment at all. Investigators at Fox Chase sought to understand if particular treatment strategies in this clinical setting improve patient survival.
“Although NCCN guidelines recommend undergoing surgery directly as the best approach for patients who are diagnosed with cT2N0 staged rectal cancer, it is not clear how these patients should be managed when cT2N0 disease is upstaged to pathologic T3N0. Specifically, there are no clear guidelines when it comes to adjuvant therapy for these patients,” said Simran Kripalani, MD, first author on the study and a general surgery resident at Temple University Hospital. Kripalani worked alongside Anthony Villano, MD, lead author on the study and Assistant Professor in the Department of Surgical Oncology at Fox Chase, as well as other researchers.
They analyzed trends in adjuvant treatments by examining 800 patients who were 18 years or older. These patients were diagnosed with clinical T2N0 rectal cancer, underwent surgery, and were subsequently upstaged to pathologic T3N0 rectal cancer. Researchers compared overall survival for patients who underwent surgery alone, surgery with adjuvant postoperative chemotherapy, surgery with postoperative chemoradiation, and surgery with postoperative radiation.
Results showed that, over time, the frequency of surgery alone decreased and the use of postoperative adjuvant therapies like chemotherapy, radiation, and chemoradiation began to rise. Patients treated with surgery alone had a five-year overall survival rate of 67.6%, which is almost 20% lower than those who were treated with adjuvant therapy. Overall survival for patients who received adjuvant chemotherapy, chemoradiation therapy, and chemotherapy plus radiation were 89.9%, 83.4%, and 90.5%, respectively.
The researchers noted that these results indicate that surgery alone may not provide the best survival benefit in comparison with adjuvant treatment strategies.
“In looking at these findings, we believe that adjuvant therapy may be underutilized in this rectal cancer setting. While results from this study have been helpful in providing us with valuable insight regarding adjuvant treatment in this group of patients, more studies are necessary so that we can begin to understand when and how these strategies can ultimately provide patients with the most benefits,” said Kripalani.
The study, “Survival Outcomes of Adjuvant Treatment in Upstaged cT2N0 Rectal Cancer: Are We Underutilizing Therapy?” was published in the Journal of Gastrointestinal Surgery, the official journal of the Society for Surgery of the Alimentary Tract.