Adjuvant therapy sparing in rectal cancer achieving complete response after chemoradiation.

Abstract

AIM:

To evaluate the long-term results of conventional chemoradiotherapy and laparoscopic mesorectal excision in rectal adenocarcinoma patients without adjuvant therapy.

METHODS:

Patients with biopsy-proven adenocarcinoma of the rectum staged cT3-T4 by endoscopic ultrasound or magnetic resonance imaging received neoadjuvant continuous infusion of 5-fluorouracil for five weeks and concomitant radiotherapy. Laparoscopic surgery was planned after 5-8 wk. Patients diagnosed with ypT0N0 stage cancer were not treated with adjuvant therapy according to the protocol. Patients with ypT1-2N0 or ypT3-4 or N+ were offered 5-fluorouracil-based adjuvant treatment on an individual basis. An external cohort was used as a reference for the findings.

RESULTS:

One hundred and seventy six patients were treated with induction chemoradiotherapy and 170 underwent total mesorectal excision. Cancer staging of ypT0N0 was achieved in 26/170 (15.3%) patients. After a median follow-up of 58.3 mo, patients with ypT0N0 had five-year disease-free and overall survival rates of 96% (95%CI: 77-99) and 100%, respectively. We provide evidence about the natural history of patients with localized rectal cancer achieving a complete response after preoperative chemoradiation. The inherent good prognosis of these patients will have implications for clinical trial design and care of patients.

CONCLUSION:

Withholding adjuvant chemotherapy after complete response following standard neoadjuvant chemoradiotherapy and laparoscopic mesorectal excision might be safe within an experienced multidisciplinary team.

• Authors: Xabier García-Albéniz, Rosa Gallego, Ralf Dieter Hofheinz, Gloria Fernández-Esparrach, Juan Ramón Ayuso-Colella, Josep Antoni Bombí, Carles Conill, Miriam Cuatrecasas, Salvadora Delgado, Angels Ginés, Rosa Miquel, Mario Pagés, Estela Pineda, Verónica Pereira, Aarón Sosa, Oscar Reig, Iván Victoria, Luis Feliz, Antonio María de Lacy, Antoni Castells, Iris Burkholder, Andreas Hochhaus, Joan Maurel
• Journal: World journal of gastroenterology (World J Gastroenterol) Vol. 20 Issue 42 Pg. 15820-9 (Nov 14 2014) ISSN: 2219-2840 [Electronic] United States
• PMID: 25400468 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antimetabolites, Antineoplastic
• Fluorouracil

Topics

• Adenocarcinoma (mortality, pathology, therapy)
• Adult
• Aged
• Aged, 80 and over
• Antimetabolites, Antineoplastic (administration & dosage)
• Biopsy
• Chemoradiotherapy
• Chemotherapy, Adjuvant
• Disease-Free Survival
• Endosonography
• Female
• Fluorouracil (administration & dosage)
• Humans
• Laparoscopy
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Neoadjuvant Therapy
• Neoplasm Staging
• Prospective Studies
• Randomized Controlled Trials as Topic
• Rectal Neoplasms (mortality, pathology, therapy)
• Spain
• Time Factors
• Treatment Outcome
• Unnecessary Procedures