PHOENIX, ARIZ. – Neoadjuvant therapy appears to be safe in patients with rectal cancer and inflammatory bowel disease, investigators from the Netherlands reported at the annual Society of Surgical Oncology Cancer Symposium.
Among Dutch patients with a diagnosis of Crohn’s disease (CD), ulcerative colitis (UC), or unspecified colitis who underwent total mesorectal excision, neither neoadjuvant therapy nor immunosuppressive therapy significantly increased the rate of acute postsurgical complications, said Dr. Stefanus van Rooijen.
Patients with inflammatory bowel disease (IBD) have typically been excluded from studies of neoadjuvant chemotherapy and radiation because of fear of complications, but this study shows that "in IBD patients, rectal cancer can be treated the same way as in patients with sporadic rectal cancer, because there were no differences in complications after operations or after getting neoadjuvant therapy," Dr. van Rooijen said in an interview.
Neil Osterweil/Frontline Medical News
Dr. Stefanus van Rooijen
To determine whether neoadjuvant therapies might make life more difficult after surgery for patients with IBD and rectal cancer, the investigators reviewed records on all patients with IBD and rectal cancer treated in the Netherlands from 1990 through 2010, and compared their cases to those other patients with rectal cancer treated in the nation during the same period.
They identified a total of 173 patients with IBD: 89 with UC, 70 with CD, and 14 with indeterminate colitis. The majority of patients (112, 64.7%) were male. The mean age at rectal cancer diagnosis was 60.7 years, and the mean duration of IBD before diagnosis was 17.4 years, Dr. van Rooijen and his colleagues at Radboud University Medical Center, Nijmegen, the Netherlands, reported in a poster.
In all, 63 patients with IBD (36.4%) received neoadjuvant therapy, including short-course radiotherapy (29 patients), long-course radiotherapy (13) and chemoradiation (21).
Of the 154 patients who went on to tumor resection, 145 had a known diagnosis of rectal cancer, with significantly more patients with UC having a preoperative rectal cancer diagnosis (90.9% vs. 72.7% for patients with CD; P = .022).
Patients with CD were significantly younger at the time of rectal cancer diagnosis, at a mean of 53.7 years, compared with 63.5 years for patients with UC, and 76 years for those with indeterminate colitis (P = .022).
In all, 42% of patients developed one or more complications after surgery, as scored by the Clavien-Dindo Classification scale (Ann. Surg. 2004;240:205-13).
The most frequent complications reported were grade 2 complications in 27.4% of cases, including presacral or intra-abdominal abscesses, perineal or abdominal wounds, or urologic problems. A total of 48 grade 3 or greater complications were seen in 41 patients.
Rates of complications were similar between patients with IBD who were on chronic immunosuppressive therapy and those who were not, and between patients who received neoadjuvant therapy of any kind and those who did not, and were similar to those seen in the general rectal cancer population, Dr. van Rooijen said.
The authors also found that because rectal cancer may go unrecognized in patients with IBD until they undergo surgery for another reason, there are a relatively high number of incomplete (R1) resections compared with patients with sporadic rectal cancers.
The study was supported by Radboud Medical Center. Dr. van Rooijen reported having no financial disclosures.