eP230 - How Does Prior Prostate Cancer Radiation Impact Rectal Cancer Manifestations and Management? A Comparative Analysis

Sunday, June 2, 2024

8:48 AM – 8:53 AM ET, USA

Location: Baltimore Convention Center, Room 318-320

ePoster Presenter(s)

Michael Goldenshluger, MD

Clinical fellow
Department of Colorectal Surgery, Clevelnd Clinic Foundation
Cleveland clinic
University heights, OH, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

MB

Mikhael Belkovsky, MD

Colorectal Surgery Research Fellow
Department of Colorectal Surgery, Cleveland Clinic
Cleveland, Ohio, United States

Disclosure information not submitted.
Ali Alipouriani, MD

Clinical Research Fellow
Department of colorectal surgery, Cleveland Clinic Foundation
Department of colorectal surgery, Cleveland Clinic Foundation
Cleveland, OH, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Kamil Erozkan, MD, FACS (he/him/his)

Clinical Research Fellow
Digestive Disease and Surgery Institute, Department of Colorectal Surgery, Cleveland Clinic
Cleveland Clinic
Cleveland, OH, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Michael A. Valente, DO

Staff Surgeon
Department of Colorectal Surgery, Cleveland Clinic
Cleveland, Ohio, United States

Disclosure information not submitted.
Scott Steele, MD MBA

President, Chairman, Staff Surgeon
Department of Colorectal Surgery, Cleveland Clinic
Cleveland, Ohio, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.
Stefan D. Holubar, MD, MS

Director of Research, Staff Surgeon
Department of Colorectal Surgery, Cleveland Clinic
Cleveland, Ohio, United States

Disclosure information not submitted.

Senior Author(s)

EG

Emre Gorgun, MD, MBA

Vice Chair, Staff Surgeon
Department of Colorectal Surgery, Cleveland Clinic
Cleveland, Ohio, United States

Disclosure information not submitted.

Purpose/Background: During radiotherapy for prostate cancer, a portion of the rectum is reached by a high radiation dose. Patients with previous radiation for a prostate cancer (PRPC) are at increased risk for the development of rectal cancer. The molecular profile, clinical characteristics and the optimal surgical and oncologic management of rectal cancers in patients with PRPC remain largely unexplored. This study aims to describe the clinical and pathological features of rectal cancer patients with PRPC.Methods/Interventions: We conducted a retrospective analysis of male patients with rectal cancer who underwent proctectomy at a single tertiary institution between the years 2000 and 2021. Patients with PRPC were compared to those with primary rectal cancer without previous radiation. Univariate analysis was carried out using R software version 4.3.1.Results/Outcomes: A total of 1,750 patients were included, of whom 45 (2.6%) had PRPC, with a median of 8 years from radiation treatment to rectal cancer diagnosis. Compared to the 1,705 control patients without PRPC, PRPC patients were older:73.7 ± 8.5 vs. 61.1 ± 13 years (p < 0.001) and had more comorbidities as indicated by higher American Society of Anesthesiologists scores (p = 0.006). The mean distance of the rectal tumor from the anal verge (4.94 ± 4.1 cm), tumor differentiation, and tumor stage were not significantly different between the groups. Seven (15.6%) patients in the PRPC group underwent neoadjuvant treatment with re-radiation therapy, in contrast to 764 (44.8%) patients of controls. The PRPC group was significantly more likely (p=0.02) to undergo extensive surgical interventions, including abdominoperineal resection (46.7% vs. 29.9%) and pelvic exenteration (4.4% vs. 0.4%), and fewer sphincter-preserving procedures, including low anterior resection (48.9% vs. 68.2%) and transanal resection (0% vs. 1.5%). Analysis of surgical pathology indicated that patients with PRPC had a higher rate of positive radial margins (11.1% vs. 4.3%, p=0.03) and angiolymphatic invasion (26.7% vs. 10.9%, p < 0.001). No significant differences were observed in postoperative outcomes, except for intra-abdominal abscesses, which were more common in RCPR patients (6.7% vs. 1.6%, p=0.04).Conclusion/

Discussion: The study sheds light on the challenges and differences in managing rectal cancer after prior prostate cancer radiation. Patients with a history of prostate cancer radiation necessitated more extensive surgical interventions and exhibited elevated occurrences of involved margins and angiolymphatic invasion.