Local Excision After Preoperative Chemoradiotherapy for Rectal Cancer

Pucciarelli, Salvatore; Paoli, Antonino De; Guerrieri, Mario; Torre, Giuseppe La; Maretto, Isacco; Marchi, Francesco; Mantello, G.; Gambacorta, Maria Antonietta; Canzonieri, Vincenzo; Nitti, Donato; Valentini, Vincenzo; Coco, Claudio

doi:10.1097/dcr.0b013e3182a2303e

Cited by 165 publications

(123 citation statements)

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“…As far as we know, no other study to date has analyzed the effects of treatment interval in a select group of ET patients. The observed overall pCR rate in ET patients in the current study was 16.1 %, which is substantially lower than reported pCR rates in recent literature of 22–44 % 6,8,9,11,30. Several issues for this discrepancy can be noted.…”

Section: Discussioncontrasting

confidence: 81%

Treatment Interval between Neoadjuvant Chemoradiotherapy and Surgery in Rectal Cancer Patients: A Population-Based Study

et al. 2016

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Background Neoadjuvant chemoradiation therapy (CRT) has been widely implemented in the treatment of rectal cancer patients, but optimal timing of surgery after neoadjuvant therapy is unclear. The purpose of this study was to evaluate the effects of prolonged intervals between long-course CRT and surgery in rectal cancer patients.MethodsData on all rectal cancer patients diagnosed between 2006 and 2011 were retrieved from the population-based Netherlands Cancer Registry; the main outcome parameters were pathologic complete response (pCR) and overall survival (OS). Outcomes were reported separately for patients with early tumors (ETs; N = 217) and locally advanced rectal cancer (LARC; N = 1073). Patients were divided into 2-week interval groups according to treatment interval, ranging from 5–6 to 13–14 weeks. Kaplan–Meier curves, and logistic regression and Cox regression models were used for data analysis.ResultsNo significant difference in pCR rate was observed for ET patients according to treatment interval. Compared with a treatment interval of 7–8 weeks, pCR rates in LARC patients were higher after 9–10 weeks (18.4 %; odds ratio [OR] 1.56, 95 % CI 1.03–2.37) and 11–12 weeks of treatment interval (20.8 %; OR 1.94, 95 % CI 1.15–3.26). Treatment interval did not influence OS in ET or LARC patients.ConclusionsTreatment intervals of 9–12 weeks between surgery and CRT seem to improve the chances of pCR in LARC patients, without an effect on OS. The length of treatment interval did not affect outcomes in patients with ET. The ongoing search for minimally invasive surgery drives the need for exploration of factors that improve pathologic response.Electronic supplementary materialThe online version of this article (doi:10.1245/s10434-016-5294-0) contains supplementary material, which is available to authorized users.

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Section: Discussioncontrasting

confidence: 81%

Treatment Interval between Neoadjuvant Chemoradiotherapy and Surgery in Rectal Cancer Patients: A Population-Based Study

et al. 2016

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“…Based on large series, it appears that for T3 cancers, 6 to 9 % of LE are performed after CRT [15,16]. This has to be interpreted cautiously as inclusion of ypT0-T1 cancers may significantly increase the LE rate [37,38]. Long-term adverse effects of preoperative radiotherapy should not be underestimated including difficulty in rectal evacuation, incontinence, erectile dysfunction and proctitis [39,40].…”

Section: Limitationsmentioning

confidence: 96%

Oncological outcomes of local excision compared with radical surgery after neoadjuvant chemoradiotherapy for rectal cancer: a systematic review and meta-analysis

Shaikh

Askari

Ourû

et al. 2014

Int J Colorectal Dis

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“…In view of the aforementioned limitations, even if surgical complications, including suture dehiscence and endoanal pain, are not uncommon among patients undergoing LE after CRT, as previously reported by us and others,18,43 this remains a procedure of investigational interest to confirm potential ypT0 status of patients with a major clinical response. On the other hand, a more conservative approach such as the “wait and see” option might be considered for patients with a complete clinical response 44.…”

Section: Discussionmentioning

confidence: 82%

“…In their study, ypT0 was noted in 22 % of the cases, and the 5-year LRFS and DMFS were respectively 100 and 96 %. Similarly, Pucciarelli et al18 reported that the 3-year LRFS was 96.9 % for 43 cT3 or low-lying cT2 rectal cancer patients treated with CRT followed by LE and observation for the ypT0-1 patients.…”

Section: Discussionmentioning

confidence: 89%

Long-Term Outcome of Rectal Cancer With Clinically (EUS/MRI) Metastatic Mesorectal Lymph Nodes Treated by Neoadjuvant Chemoradiation: Role of Organ Preservation Strategies in Relation to Pathologic Response

et al. 2016

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BackgroundOrgan preservation strategies are under investigation for patients with locally advanced rectal cancer (LARC) who achieve a complete pathologic response in the primary tumor (ypT0) after neoadjuvant chemoradiation therapy (CRT). This study explored the value of this approach for cN+ patients.MethodsData were retrieved from our institutional prospective rectal cancer database. Tumors with mesorectal lymph nodes larger than 5 mm shown on endorectal ultrasonography, pelvic magnetic resonance imaging, or both were staged as cN+.ResultsThe study population comprised 226 patients (142 men and 84 women; median age, 64 years) with LARC who underwent CRT followed by surgery including total mesorectal excision (TME) (n = 179) and full-thickness local excision (LE) (n = 47) between 1996 and 2013. At staging, 123 patients (54.4 %) were cN+. In 65 cases (28.7 %), ypCR was observed. Metastatic mesorectal lymph nodes (ypN+) were detected in 41.6 % of the cN+ patients and in 2.8 % of the cN0 patients (P < 0.01). Among the cN+ patients, 16 % of the ypT0 cases were ypN+ compared with 51.8 % of the no-ypT0 cases (P < 0.01). Among the cN+ patients who underwent TME, the 5-year disease-specific survival (DSS) and disease-free survival (DFS) rates were respectively 100 and 91.6 % for the ypT0 patients compared with 71.2 and 58.0 % for the no-ypT0 patients (P = 0.01). Among the ypN+ patients, the 5-year DSS and DFS rates were both 100 % for the ypT0 cases compared with 59.1 and 43.3 % for the no-ypT0 patients. Among the cN+ and ypT0 patients, the 5-year DSS and DFS were respectively 100 and 85.7 % for the TME patients compared with 100 and 91.6 % for the LE patients. In the multivariate analysis, ypT0 was the only independent prognostic factor.ConclusionsProtocols aimed at organ preservation in LARC that achieve ypT0 after CRT can be offered also to cN+ patients.

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Local Excision After Preoperative Chemoradiotherapy for Rectal Cancer

Abstract: Our data suggest that local excision is a good option for patients with a major clinical response after chemoradiotherapy. A longer period of follow-up is required to confirm these findings.

Cited by 165 publications

References 35 publications

Treatment Interval between Neoadjuvant Chemoradiotherapy and Surgery in Rectal Cancer Patients: A Population-Based Study

Treatment Interval between Neoadjuvant Chemoradiotherapy and Surgery in Rectal Cancer Patients: A Population-Based Study

Oncological outcomes of local excision compared with radical surgery after neoadjuvant chemoradiotherapy for rectal cancer: a systematic review and meta-analysis

Long-Term Outcome of Rectal Cancer With Clinically (EUS/MRI) Metastatic Mesorectal Lymph Nodes Treated by Neoadjuvant Chemoradiation: Role of Organ Preservation Strategies in Relation to Pathologic Response

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