Changes in nationwide use of preoperative radiotherapy for rectal cancer after revision of the national colorectal cancer guideline.

Autor: Gietelink L; Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: liekegietelink@gmail.com., Wouters MWJM; Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands; Scientific Board, Dutch Institute of Clinical Auditing, Leiden, The Netherlands., Marijnen CAM; Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands., van Groningen J; Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands., van Leersum N; Scientific Board, Dutch Institute of Clinical Auditing, Leiden, The Netherlands., Beets-Tan RGH; Department of Radiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands., Tollenaar RAEM; Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands., Tanis PJ; Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Jazyk: angličtina
Zdroj: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology [Eur J Surg Oncol] 2017 Jul; Vol. 43 (7), pp. 1297-1303. Date of Electronic Publication: 2017 Mar 10.
DOI: 10.1016/j.ejso.2016.12.019
Abstrakt: Background: The rate of preoperative radiotherapy (RT) for rectal cancer in the Netherlands has been the highest among European countries. Revision of the national guideline on colorectal cancer, officially published in 2014, specifically focussed on the indication for RT and MRI criteria to evaluate mesorectal lymph nodes. The objective of this study was to evaluate implementation of the revised guideline using a national audit.
Methods: Data of the Dutch Surgical Colorectal Audit (DSCA) between 2009 and 2014 were used to evaluate RT use and RT regimen for relevant subgroups of cM0 rectal cancer patients, as well as accuracy of pre-operative MRI.
Results: 14,018 patients were included for analysis. Overall RT use in cT1-4N0-2M0 stage ranged from 81.4% to 84.2% between 2009 and 2013, and decreased to 64.4% in 2014. The absolute decrease in RT use from 2013 to 2014 for cT1N0, cT2N0 and cT3N0 stage was 32.8%, 43.5% and 31.6%, respectively. Short course RT with delayed surgery was used as an alternative to chemoradiotherapy up to 2013 in 30.6% of patients over 80 years, and in 12.1% of patients with an ASA score >2; these percentages increased to 45.8% and 19.9% in 2014, respectively. Specificity of MRI for N-stage decreased from 82.9% in 2009 to 62.9% in 2013, with an increase to 73.2% in 2014.
Conclusion: The revised national guideline on colorectal cancer was rapidly implemented in the Netherlands with a substantial decrease in RT use for low risk resectable rectal cancer, and increased specificity of MRI for N-staging.
(Copyright © 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)
Databáze: MEDLINE
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