Adjuvant chemotherapy may improve disease-free survival in patients with rectal cancer positive for MRI-detected extramural venous invasion following chemoradiation.
OBJECTIVE
MRI-detected extramural venous invasion (mrEMVI) is a poor prognostic factor in rectal cancer. Preoperative chemoradiotherapy (CRT) can cause regression in the severity of EMVI and subsequently improve survival whereas mrEMVI persisting after CRT confers an increased risk of recurrence. The effect of adjuvant chemotherapy (AC) following CRT on survival in rectal cancer remains unclear. The aim of this study was to determine whether there is a survival advantage for AC given to patients with mrEMVI persisting after CRT.


METHODS
A prospective analysis was conducted of consecutive patients with locally advanced rectal cancer between 2006 and 2013. All patients underwent CRT followed by surgery. AC was given to selected patients based on the presence of specific 'high-risk' features. Comparison was made between patients offered AC with observation alone. The primary outcome was 3-year disease-free survival (DFS).


RESULTS
Of 631 patients, 227 (36.0%) demonstrated persistent mrEMVI following CRT. Patients were grouped on the basis of AC or observation and were matched for age, performance status and final histopathological staging. Three-year DFS in the AC group was 74.6% compared with 53.7% in the observation only group. AC had a survival benefit on multivariate analysis (hazard ratio 0.458; 95% CI: 0.271-0.775, P = 0.004).


CONCLUSIONS
Patients with persistent mrEMVI following CRT who receive AC may have a decreased risk of recurrence and an improved 3-year DFS compared with patients not receiving AC, irrespective of age and performance status.
Department of Surgery, University College London Hospital, London, UK.|Department of Radiology, Royal Marsden Hospital, Sutton, UK.|Department of Surgery and Cancer, Imperial College London, London, UK.
M
M
Chand
Department of Surgery and Cancer, Imperial College London, London, UK.|Department of Surgery and Cancer, Royal Marsden Hospital, London, UK.
S
S
Rasheed
Pelican Cancer Foundation, Basingstoke, UK.
R
R
Heald
Croydon University Hospital, London, UK.
I
I
Swift
Department of Pathology and Molecular Biology, Leeds University Hospital, Leeds, UK.
N
N
West
Department of Surgery and Cancer, Royal Marsden Hospital, London, UK.
S
S
Rao
Department of Surgery and Cancer, Imperial College London, London, UK.|Department of Surgery and Cancer, Royal Marsden Hospital, London, UK.
P
P
Tekkis
Department of Radiology, Royal Marsden Hospital, Sutton, UK.|Department of Surgery and Cancer, Imperial College London, London, UK.
G
G
Brown
D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D059248:Chemoradiotherapy / Q000009:adverse effects*; D017024:Chemotherapy, Adjuvant / Q000379:methods; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000000981:diagnostic imaging; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D012007:Rectum / Q000098:blood supply / Q000473:pathology; D012189:Retrospective Studies; D016896:Treatment Outcome
D000970:Antineoplastic Agents
MRI; chemotherapy; rectal cancer; venous invasion