Review
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World J Gastroenterol. Aug 28, 2013; 19(32): 5227-5237
Published online Aug 28, 2013. doi: 10.3748/wjg.v19.i32.5227
Risk factors for local recurrence following neoadjuvant chemoradiotherapy for rectal cancers
Jia-Yuan Peng, Zhong-Nan Li, Yu Wang
Jia-Yuan Peng, Zhong-Nan Li, Yu Wang, Department of Surgery, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
Author contributions: Peng JY and Li ZN contributed equally to this work; Peng JY reviewed the literature and wrote the article; Li ZN contributed to the analysis and interpretation of the data; Wang Y designed the review and revised the article; all authors have read and approved the final version to be published.
Correspondence to: Yu Wang, Professor, Department of Surgery, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, 600 Yishan Road, Shanghai 200233, China. wangyu11122@126.com
Telephone: +86-21-64361349 Fax: +86-21-64368920
Received: April 5, 2013
Revised: July 3, 2013
Accepted: July 17, 2013
Published online: August 28, 2013
Processing time: 141 Days and 4 Hours
Abstract

Local recurrence (LR) has an adverse impact on rectal cancer treatment. Neoadjuvant chemoradiotherapy (nCRT) is increasingly administered to patients with progressive cancers to improve the prognosis. However, LR still remains a problem and its pattern can alter. Correspondingly, new risk factors have emerged in the context of nCRT in addition to the traditional risk factors in patients receiving non-neoadjuvant therapies. These risk factors are decisive when reviewing treatment options. This review aims to elucidate the distinctive risk factors related to LR of rectal cancers in patients receiving nCRT and to clarify their clinical significance. A search was conducted on PubMed to identify original studies investigating patients with rectal cancer receiving nCRT. Outcomes of interest, especially potential risk factors for LR in patients with nCRT, were then analyzed. The clinical importance of these risk factors is discussed. Remnant cancer cells, lymph-nodes and tumor response were found to be major risk factors. Remnant cancer cells decide the status of resection margins. Local excision following nCRT is promising in ypT0-1N0M0 cases. Dissection of lateral lymph nodes should be considered in advanced low-lying cancers. Although better tumor response resulted in a relatively lower recurrence rate, the evidence available is insufficient to justify a non-operative approach in clinical complete responders to nCRT. LR cannot be totally avoided by current multidisciplinary approaches. The related risk factors resulting from nCRT should be considered when making decisions regarding treatment selection.

Keywords: Local recurrence; Rectal cancer; Neoadjuvant chemoradiotherapy

Core tip: This review identifies the distinctive risk factors associated with local recurrence (LR) in patients with rectal cancer receiving neoadjuvant therapy. These factors are different from the traditional risk factors seen in patients treated with surgery and/or adjuvant therapy alone. The clinical significance of these risk factors is clarified in detail. To our knowledge, no reviews concerning this topic have been published. The present manuscript might help to understand the origin of LR following neoadjuvant chemoradiotherapy and may receive attention from investigators devoted to improving the prognosis of rectal cancer.