| Nonoperative management of rectal cancer with complete clinical response after neoadjuvant therapy. | |
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MedLine Citation:
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PMID: 23154394 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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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. |
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Authors:
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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 |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Annals of surgery Volume: 256 ISSN: 1528-1140 ISO Abbreviation: Ann. Surg. Publication Date: 2012 Dec |
Date Detail:
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Created Date: 2012-11-16 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0372354 Medline TA: Ann Surg Country: United States |
Other Details:
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Languages: eng Pagination: 965-72 Citation Subset: AIM; IM |
Affiliation:
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*Departments of Surgery †Radiation Oncology ‡Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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