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Publications

Journal Article Observational Study Multicenter Study Ppublish

PubMed: 41518072 DOI: 10.1111/codi.70358

Contemporary neoadjuvant strategies for rectal cancer: The GRECCAR snapshot study.

Colorectal Dis 28(1):e70358

Authors: Antoine Cazelles, Quentin Denost, Benjamin Fernandez, Michel Rivoire, Hélène Meillat, Philippe Rouanet, Mehdi Karoui, Adeline Germain, Leon Maggiori, Alain Valverde, Nicolas Peru, Eddy Cotte, Etienne Buscail, Jeremie H Lefevre, Bertrand Trilling, Jean Luc Faucheron, Pierre Yves Sage, Laura Beyer-Berjot, Stephane Benoist, Arnaud Alves, Charles Sabbagh, Jean-Jacques Tuech, Julien Coget, Frédéric Marchal, Guillaume Meurette, Diane Mège, Dahbia Djelil, Simone Manfredelli, Aurélien Venara, Mehdi Ouaissi, Gilles Manceau

Affiliations

  • Department of Digestive and Oncological Surgery, Georges Pompidou University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France.
  • Bordeaux Colorectal Institute, Clinique Tivoli-Ducos, Bordeaux, France.
  • Department of Digestive Surgery, Colorectal Unit, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France.
  • Department of Surgical Oncology, Centre Léon Bérard, Comprehensive Cancer Center, Lyon, France.
  • Department of Digestive Surgical Oncology, Institute Paoli-Calmettes, Marseille, France.
  • Department of Oncological Surgery, Val d'Aurelle Institut, Montpellier, France.
  • Department of Digestive Surgery, CHRU Nancy, Nancy, France.
  • Department of Digestive Surgery, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France.
  • Department of Digestive Surgery, Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, France.
  • Department of Digestive Surgery, CHU Lyon-Sud, Pierre-Bénite, France.
  • Department of Surgery, CHU Toulouse-Rangueil and Toulouse University, Toulouse, France.
  • Department of General and Digestive Surgery, Saint-Antoine Hospital, Assistance Publique Hôpitaux de Paris, Sorbonne University, Paris, France.
  • Department of Digestive and Emergency Surgery, Grenoble Alpes University, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, Grenoble Alpes University Hospital, Grenoble, France.
  • Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France.
  • Department of Digestive Surgery, North University Hospital, Assistance Publique Hôpitaux de Marseille, Marseille, France.
  • Department of Digestive and Oncological Surgery, CHU Bicètre, Le Kremlin-Bicêtre, France.
  • Department of Digestive Surgery, University of Caen Normandy, Caen, France.
  • UMR 1086 INSERM Unity ANTICIPE, Caen Normandy University, Caen, France.
  • Department of Digestive, Amiens University Hospital, Amiens, France.
  • Department of Digestive Surgery, University Hospital of Rouen, Rouen, France.
  • Department of Surgery, University of Lorraine, Cancer Institute of Lorraine, Vandœuvre-lès-Nancy Cedex, France.
  • Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland.
  • Department of Digestive Surgery, Aix Marseille Univ, Assistance Publique Hôpitaux de Marseille, Timone University Hospital, Marseille, France.
  • Department of Digestive Surgery, La Pitié Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Sorbonne University, Paris, France.
  • Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France.
  • Department of Digestive Surgery, University Hospital of Angers, Angers, France.
  • Department of Digestive, Oncological, Endocrine, Hepatobiliary, and Liver Transplant, Trousseau Hospital, University Hospital of Tours, Tours, France.

Abstract

AIM

Neoadjuvant treatment for rectal cancer has evolved markedly with the growing adoption of total neoadjuvant therapy (TNT), organ-preservation strategies and selective omission of radiotherapy. Recent trials support risk-based personalization, but its application in real-world settings remains poorly documented. The aim was to describe current neoadjuvant treatment practices for mid-low rectal cancer in French expert centres and identify tumour- and patient-related factors influencing decisions.

METHOD

This observational study included patients with non-metastatic rectal adenocarcinoma ≤10 cm from the anal verge, discussed in tumour boards (October 2022 to March 2023) across GRECCAR centres. Tumours were classified as early, intermediate-risk or locally advanced rectal cancer (LARC). Neoadjuvant treatments were analysed according to tumour extension, location and age.

RESULTS

Among 463 patients from 27 centres, the most frequent regimen was induction chemotherapy, mainly FOLFIRINOX, followed by long-course chemoradiotherapy (CRT) (65%). This approach was used in 51%, 66% and 71% of patients in the early, intermediate-risk and LARC groups, respectively (p = 0.0060). TNT was more frequently administered for low- than mid-rectal cancers, especially in LARC (86% vs. 71%, p = 0.016). In patients >75 years, CRT + consolidation chemotherapy and radiotherapy alone were proportionally more frequent. Among the early rectal cancers, those treated with induction chemotherapy + CRT had more advanced features than those treated with CRT alone (cT3: 80% vs. 43%, cN+: 62% vs. 10%, tumour size: 3.4 vs. 2.3 cm; all p < 0.001).

CONCLUSION

TNT with induction chemotherapy is the predominant neoadjuvant approach in French expert centres. Tumour classification, location and patient age significantly influence treatment choices, reflecting a shift towards personalized context-specific care.

MeSH

Radiotherapy, Induction Chemotherapy, Neoplasms, Drug Therapy, Neoadjuvant Therapy, Rectal Neoplasms, Therapeutics, Chemotherapy