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AUDIT OF DOWN-STAGING CHEMORADIATION FOR LOCALLY ADVANCED RECTAL CANCER

AUDIT OF DOWN-STAGING CHEMORADIATION FOR LOCALLY ADVANCED RECTAL CANCER. DR J J NICOLL NORTH CUMBRIA UNIVERSITY HOSPITALS SEPTEMBER 2012. STANDARD. Aim is to achieve complete surgical resection with Circumferential Resection Margin (CRM) >1mm

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AUDIT OF DOWN-STAGING CHEMORADIATION FOR LOCALLY ADVANCED RECTAL CANCER

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  1. AUDIT OF DOWN-STAGING CHEMORADIATION FOR LOCALLY ADVANCED RECTAL CANCER DR J J NICOLL NORTH CUMBRIA UNIVERSITY HOSPITALS SEPTEMBER 2012

  2. STANDARD • Aim is to achieve complete surgical resection with Circumferential Resection Margin (CRM) >1mm • Success measured as number of CRM –ve resections and number of complete pathological responses (pCR) • No nationally or internationally agreed standards. • Meta-analysis of trials of pre-op CRT 2524 pts – pCR 10% • Retrospective data on 677 pts from 6 UK centres – CRM –ve 70%; pCR 13% • Denominator uncertain, different criteria for treatment. • Aim to compare with data published in 2005 from Mount Vernon & “pooled series” from 7 UK centres .

  3. METHODS • RT database searched for patients receiving DXT (>23 fractions) and chemotherapy first registered 2006-2010. • 76 pts identified as having radical chemoradiation (CRT) for rectal cancer. • Database records examined – 12 patients were excluded because treatment was post-op, palliative or given for local recurrence. • Remaining 64 pts. analysed for results of down-staging CRT.

  4. TREATMENT • 45GY/25# to Isocentre • Capecitabine 825 mg/sq.m b.d throughout DXT weekends included. • Restage (CT CAP & MRI) 6-10 weeks later.

  5. RESULTS • 41/64 (64%) underwent attempted resection. • 23/64 (36%) had no surgery.

  6. REASONS FOR NO RESECTION

  7. RESULTS OF RESECTION(resected patients only)

  8. RESULTS OR TREATMENT(ALL 64 PATIENTS)

  9. COMPARISONS- OPERATED

  10. COMPARISONS – RO RESECTIONS

  11. COMPARISONS - pCR

  12. NOTES • Mount Vernon series (150 pts) did not repeat CT scan after CRT. • 5 NCUH pts had mets on post-CRT CT scan and didn’t have surgery. • No details of re-staging for “pooled series” (680 pts) • MV series includes “borderline resectable” – no clear definition • “Pooled series” included “locally advanced” – no definition given. • We are not necessarily comparing like with like. • Published series used FU/FA, not capecitabine. • 4 records not found – treated as not having surgery.

  13. CONCLUSIONS • NCUH results are similar to two large UK series. • Populations treated are similar but not strictly identical. • NCUH standards are in line with other published results

  14. ACTIONS • Continue to offer down-staging CRT to patients identified at MDT to have threatened margins by MRI criteria. • Offer suitable patients chance to participate in ARISTOTLE trial in the hope of improving results through the use of better chemotherapy.

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