Document Detail


Nonoperative management of rectal cancer with complete clinical response after neoadjuvant therapy.
MedLine Citation:
PMID:  23154394     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
INTRODUCTION: : Nonoperative management (NOM) of rectal cancer after a complete clinical response (cCR) to neoadjuvant therapy is controversial. In this article, we retrospectively reviewed the outcomes of patients managed with selective NOM after a cCR to neoadjuvant treatment and compared these with patients who underwent standard rectal resection with a pathological complete response (pCR).
METHODS: : Patients completing neoadjuvant chemoradiotherapy (CRT) for stage I to III rectal cancer between January 2006 and August 2010 were retrospectively reviewed. Median follow-up was calculated in months after completion of CRT.
RESULTS: : Thirty-two patients (median follow-up 28 months) were treated by NOM after a cCR. Among 265 treated by CRT and rectal resection, 57 patients (22%) had a pCR and formed the control group (median follow-up 43 months). Factors associated with selective use of NOM included lower pretreatment stage, older age, and distal tumor location (P < 0.05). In the NOM group, 6 recurred locally (median 11 months, range 7-14), 3 of whom also had concurrent distant recurrence. All 6 local failures were controlled by salvage rectal resection with no further local recurrence of disease (median follow-up 17 months). In the rectal resection/pCR group, there were no local failures. The 2-year distant disease-free survival (88% vs 98%, P = 0.27) and overall survival (96% vs 100%, P = 0.56) were similar for NOM and rectal resection/pCR groups.
CONCLUSIONS: : Rectal resection was successfully avoided in 81% of patients selected for NOM. When combined with salvage surgery, NOM appears to achieve similar local and distant disease control compared with patients with a pCR treated by rectal resection. Longer follow-up and prospective trials are warranted to evaluate this promising treatment option.
Authors:
James D Smith; Jeannine A Ruby; Karyn A Goodman; Leonard B Saltz; José G Guillem; Martin R Weiser; Larissa K Temple; Garrett M Nash; Philip B Paty
Related Documents :
20186104 - Metastatic primary angiosarcoma of the breast in a pediatric patient with a complete re...
7712444 - Ten-year results in 1070 patients with stages i and ii breast cancer treated by conserv...
9349314 - Does concomitant chemoradiotherapy influence cosmetic outcome in conservative treatment...
24222104 - State of the art in the treatment of laryngeal cancer.
20237004 - Assessing oncologic benefit in clinical trials of immunotherapy agents.
17429644 - Actual role of radiofrequency ablation of liver metastases.
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of surgery     Volume:  256     ISSN:  1528-1140     ISO Abbreviation:  Ann. Surg.     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  965-72     Citation Subset:  AIM; IM    
Affiliation:
*Departments of Surgery †Radiation Oncology ‡Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Axillary Dissection Versus No Axillary Dissection in Older Patients With T1N0 Breast Cancer: 15-Year...
Next Document:  Changes of quality of life in gastric cancer patients after curative resection: a longitudinal cohor...