Overall treatment outcome - analysis of long-term results of rectal cancer treatment on the basis of a new parameter

Michal Jankowski; Dariusz Bała; Manuela Las-Jankowska; Wojciech Maria Wysocki; Tomasz Nowikiewicz; Wojciech Zegarski

doi:10.5114/aoms.2020.94330

Overall treatment outcome - analysis of long-term results of rectal cancer treatment on the basis of a new parameter

Arch Med Sci. 2020 Apr 8;16(4):825-833. doi: 10.5114/aoms.2020.94330. eCollection 2020.

Authors

Michal Jankowski^{1

2}, Dariusz Bała^{1

2}, Manuela Las-Jankowska^{1

3}, Wojciech Maria Wysocki^{4

5

6}, Tomasz Nowikiewicz^{1

7}, Wojciech Zegarski^{1

2}

Affiliations

¹ Chair of Surgical Oncology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland.
² Department of Surgical Oncology, Oncology Center - Prof. Franciszek Lukaszczyk Memorial Hospital, Bydgoszcz, Poland.
³ Department of Clinical Oncology, Oncology Center - Prof. Franciszek Lukaszczyk Memorial Hospital, Bydgoszcz, Poland.
⁴ Department of General, Oncological and Vascular Surgery, 5th Military Clinical Hospital, Krakow, Poland.
⁵ Chair of Surgery, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland.
⁶ National Institute of Oncology, Maria Skłodowska-Curie Memorial, Scientific Editorial Office, Krakow, Poland.
⁷ Department of Breast Cancer and Reconstruction Surgery, Oncology Center - Prof. Franciszek Lukaszczyk Memorial Hospital, Bydgoszcz, Poland.

Abstract

Introduction: Outcomes of rectal cancer treatment depend on preoperative staging and the effectiveness of treatments. According to disease staging, different variants of combined therapy (surgery, chemo- and radiotherapy) are used. Available parameters such as overall survival rates and disease- free survival rates as well as the presence of recurrence are inaccurate and should be jointly considered.

Material and methods: Data from 138 patients with rectal cancer (I-III WHO), who were radically operated on in the period 2001-2004 in Bydgoszcz Oncology Centre were analysed. Among this group 84 patients were radically operated on one week after preoperative radiotherapy 5 × 5 Gy (sRT). We established a new parameter, the overall treatment outcome (OTO), based on the finding that there was no recurrence (local recurrence, distant metastases) of the disease within 5 years, which is generally considered a good result for the treatment of rectal cancer.

Results: Among all patients (n = 138) and patients following sRT (n = 84) 7.4%...5.9% local recurrence and 24%...29% distant metastases were observed in 5-year follow-up. Recurrence was found in 30% and 31% of patients, respectively. Analysis of results on the basis of the OTO parameter demonstrated that among all groups of patients a worse treatment outcome is related to the number of lymph nodes involved, pN, pT, cancer stage (WHO) and to pN and patient age in the sRT group (p < 0.005).

Conclusions: In using a combined therapy, it is possible to optimise rectal cancer treatment outcomes. The OTO parameter is a useful tool for defining these results of cancer combination treatment.

Keywords: combined therapy; rectal cancer; treatment outcomes.