Optimal interval of surgery after neoadjuvant radiochemotherapy in T3-4/N0+ rectal cancer: population level evidence in addition to controlled trial
Letter to the Editor

Optimal interval of surgery after neoadjuvant radiochemotherapy in T3-4/N0+ rectal cancer: population level evidence in addition to controlled trial

William Tzu-Liang Chen1,2*, Tao-Wei Ke1*, Yu-Min Liao3*, Chia-Chin Li4*, Chun-Ru Chien2,5

1Department of Colorectal Surgery, 2School of Medicine, College of Medicine, 3Division of Hematology and Oncology, Department of Internal Medicine, 4Cancer Center, 5Department of Radiation Oncology, China Medical University Hospital, Taichung 40402, Taiwan

*These authors contributed equally to this work.

Correspondence to: Chun-Ru Chien, MD, PhD. School of Medicine, College of Medicine, China Medical University, No. 91 Hsueh-Shih Road, North District, Taichung 40402, Taiwan. Email: d16181@mail.cmu.edu.tw.

Submitted Nov 10, 2014. Accepted for publication Nov 14, 2014.

doi: 10.3978/j.issn.2078-6891.2014.106

We congratulated the study by Saglam et al. from Turkey (1) for providing efficacy data regarding optimal interval of surgery after neoadjuvant radiochemotherapy in locally advanced rectal cancer. However, what seen in controlled trial (efficacy) might not be seen in population real practice (effectiveness) (2). To our knowledge, this issue still remained controversial (3) and there was only one population level study from the Netherlands (4). Therefore, we would like to provide supplementary population level evidence from Taiwan.

From national cancer registry in Taiwan, we identified 891 rectal cancer patients received neoadjuvant concurrent systematic therapy and radiotherapy within 2007-2010. Among those who were clinically staged as T3-4/N0+ and received subsequent proctectomy, we conducted a propensity-score match analysis to compare the outcome between long (within 7-9 weeks) or short interval (within 3-5 weeks) between neoadjuvant therapy and surgery so as to minimal bias using clinical-pathological covariables based on our previous research experiences (5-10). Among 220 matched patients, we found the rate of pathological complete remission (15.45% vs. 11.82%), margin-involvement rate (3.64% vs. 5.45%), or 5-year survival rate (78.43% vs. 70.28%) were all similar between these two groups [P=0.5716 (McNemar test), 0.7539 (McNemar test), 0.6952 (stratified log-rank test), respectively]. We believed this population-level information would be helpful regarding decision for optimal timing for surgery before further evidences available.

Acknowledgements

Funding: This work was supported by the Health and Welfare Surcharge of Tobacco Products, China Medical University Hospital Cancer Research Center of Excellence, Taiwan (MOHW104-TD-B-111-03). The data analyzed in this study was provided by the Collaboration Centre for Health Information Application (CCHIA), Ministry of Health and Welfare, Executive Yuan, Taiwan.

Disclosure: The authors declared no conflict of interest.

References

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Cite this article as: Chapman TR, Kumarapeli AR, Nyflot MJ, Bowen SR, Yeung RS, Vesselle HJ, Yeh MM, Apisarnthanarax S. Functional imaging of radiation liver injury in a liver metastasis patient: imaging and pathologic correlation. J Gastrointest Oncol 2015;6(3):E38-E39. doi: 10.3978/j.issn.2078-6891.2015.002

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