Impact of Time Interval Between Chemoradiation and Surgery on Pathological Complete Response and Survival in Rectal Cancer

  • Akbar, Ali (Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital Research Centre) ;
  • Bhatti, Abu Bakar Hafeez (Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital Research Centre) ;
  • Niazi, Samiullah Khan (Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital Research Centre) ;
  • Syed, Amir Ali (Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital Research Centre) ;
  • Khattak, Shahid (Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital Research Centre) ;
  • Raza, Syed Hassan (Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital Research Centre) ;
  • Kazmi, Ather Saeed (Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital Research Centre)
  • Published : 2016.02.05


Background: Limited data are available regarding the impact of time duration between chemoradiation (CRT) and surgery on pathological complete response (PCR). A PCR translates into better overall and disease free survival. The objective of this study was to determine effect of time duration on outcome after preoperative CRT in rectal cancer. Materials and Methods: A retrospective review of patients undergoing operations for rectal adenocarcinoma between January 2005 and December 2010 was performed. Patients were divided in two groups: Group 1 underwent surgery in ${\leq}8weeks$ post neoadjuvant CRT and Group 2 after 8 weeks. Patient characteristics, surgical procedure, histopathological details and number of loco-regional and distant failures were compared. Expected 5 year overall survival and disease free survival was calculated using Kaplan Meier curves and significance was determined using the log rank test. Results: There were 66 patients in group 1 and 93 in group 2. No significant difference in PCR was observed between the two. However, estimated 5 year DFS was significantly higher in Group 1 (66.7%) as compared to Group 2 (53.8%) (P=0.04). Estimated overall 5 year overall survival was not significantly different at 68.2% versus 54.3% (P= 0.09). Conclusions: Delaying surgery more than 8 weeks after preoperative CRT does not impact for PCR in rectal cancer.


Rectal cancer;PCR;chemotherapy;radiation;delay in surgery;survival


  1. Akbar A, Bhatti AB, Khattak S, et al (2014). Outcome of rectal cancer in patients aged 30 years or less in the Pakistani population. Asian Pac J Cancer Prev, 15, 6339-42
  2. Beart RW Jr (2007). Multidisciplinary management of patients with advanced rectal cancer. Clin Cancer Res, 13, 6890-93
  3. Bhatti AB, Waheed A, Hafeez A, et al (2015).Can induction chemotherapy before concurrent chemoradiation impact circumferential resection marginpositivity and survival in low rectal cancers? Asian Pac J Cancer Prev, 16, 2993-8
  4. Bray F, Ren JS, Masuyer E, et al (2013). Estimates of global cancer prevalence for 27 sites in the adult population in 2008. Int J Cancer, 132, 1133-45.
  5. Cellini F, Valentini V (2012). Current perspectives on preoperative integrated treatments for locally advanced rectal cancer: a review of agreement and controversies. Oncol Williston Park, 26, 730-5.
  6. Cervantes A, Rodriguez-Braun E, Navarro S, et al (2007). Integrative decisions in rectal cancer. Ann Oncol, 18, 127-131.
  7. Cohen SM, Neugut AI (2004). Adjuvant therapy for rectal cancer in the elderly. Drugs Aging, 21, 437-451
  8. Coucke PA, Notter M, Matter M, et al (2006). Effect of timing of surgery on survival after preoperative hyperfractionated accelerated radiotherapy (HART) for locally advanced rectal cancer (LARC): is it a matter of days? Acta Oncol, 45, 1086-93
  9. De Campos-Lobato LF, Geisler DP, da Luz Moreira A, et al (2011). Neoadjuvant therapy for rectal cancer: the impact of longer interval between chemoradiation and surgery. J Gastrointest Surg, 15, 444-50
  10. Dhadda AS, Zaitoun AM, Bessell EM (2009). Regression of rectal cancer with radiotherapy with or without concurrent capecitabine - optimising the timing of surgical resection. Clin Oncol, 21, 23-31.
  11. Dolinsky CM, Mahmoud NN, Mick R, et al (2007). Effect of time interval between surgery and preoperative chemoradiotherapy with 5-fluorouracil or 5-fluorouracil and oxaliplatin on outcomes in rectal cancer. J Surg Oncol, 96, 207-12.
  12. Du CZ, Chen YC, Cai Y, et al (2011). Oncologic outcomes of primary and post-irradiated early stage rectal cancer: a retrospective cohort study. World J Gastroenterol, 17, 3229-34
  13. Garcia-Aguilar J, Smith DD, Avila K, et al (2011). Timing of rectal cancer response to chemoradiation consortium. optimal timing of surgery after chemoradiation for advanced rectal cancer: preliminary results of a multicenter, nonrandomized phase II prospective trial. Ann Surg, 254, 97-102.
  14. Jemal A, Siegel R, Xu J, et al (2010). Cancer statistics, CA Cancer J Clin, 60, 277-300
  15. Kalady MF, de Campos-Lobato LF, Stocchi L, et al (2009). Predictive factors of pathologic complete response after neoadjuvant chemoradiation for rectal cancer. Ann Surg. 250, 582-9
  16. Kerr SF, Norton S, Glynne-Jones R (2008). Delaying surgery after neoadjuvant chemo radiotherapy for rectal cancer may reduce postoperative morbidity without compromising prognosis. Br J Surg, 95, 1534-40
  17. Lim SB, Choi HS, Jeong SY, et al (2008). Optimal surgery time after preoperative chemoradiotherapy for locally advanced rectal cancers. Ann Surg, 248, 243-251.
  18. Moore HG, Gittleman AE, Minsky BD, et al (2004). Rate of pathologic complete response with increased interval between preoperative combined modality therapy and rectal cancer resection. Dis Colon Rectum, 47, 279-86.
  19. National Comprehensive Cancer Network (2013). NCCN clinical practice guidelines in oncology, Rectal cancer. Accessed: September, 26.
  20. Petersen SH, Harling H, Kirkeby LT, et al (2012). Postoperative adjuvant chemotherapy in rectal cancer operated for cure. Cochrane Database Syst Rev, 3, 4078
  21. Popek S, Tsikitis VL (2011). Neoadjuvant vs adjuvant pelvic radiotherapy for locally advanced rectal cancer: Which is superior? World J Gastroenterol, 17, 848-54
  22. Rubbia-Brandt L, Giostra E, Brezault C, et al (2007). Importance of histological tumor response assessment in predicting the outcome in patients with colorectal liver metastases treated with neo-adjuvant chemotherapy followed by liver surgery. Ann Oncol, 18, 299-304
  23. Sauer R, Becker H, Hohenberger W, et al (2004). Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med, 351, 1731-40.
  24. Stein DE, Mahmoud NN, Anne PR, et al (2003). Longer time interval between completion of neoadjuvant chemoradiation and surgical resection does not improve downstaging of rectal carcinoma. Dis Colon Rectum, 46, 448-53
  25. Supiot S, Bennouna J, Rio E, et al (2006). Negative influence of delayed surgery on survival after preoperative radiotherapy in rectal cancer. Colorectal Dis, 8, 430-5
  26. Tran CL, Udani S, Holt A, et al (2006). Evaluation of safety of increased time interval between chemoradiation and resection for rectal cancer. Am J Surg, 192, 873-7
  27. Tulchinsky H, Shmueli E, Figer A, et al (2008). An interval >7weeks between neoadjuvant therapy and surgery improves pathologic complete response and disease-free survival in patients with locally advanced rectal cancer. Ann Surg Oncol, 15, 2661-7
  28. Wang Y, Cummings B, Catton P, et al (2005). Primary radical external beam radiotherapy of rectal adenocarcinoma: long term outcome of 271 patients. Radiother Oncol, 77, 126-32.
  29. Wolthuis AM, Penninckx F, Haustermans K, et al (2012). Impact of interval between neoadjuvant chemoradiotherapy and TME for locally advanced rectal cancer on pathologic response and oncologic outcome. Ann Surg Oncol, 19, 2833-41

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