Nonoperative management of rectal cancer with complete clinical response after neoadjuvant therapy Journal Article

Authors: Smith, J. D.; Ruby, J. A.; Goodman, K. A.; Saltz, L. B.; Guillem, J. G.; Weiser, M. R.; Temple, L. K.; Nash, G. M.; Paty, P. B.
Article Title: Nonoperative management of rectal cancer with complete clinical response after neoadjuvant therapy
Abstract: 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. Copyright © 2012 by Lippincott Williams & Wilkins.
Keywords: adult; controlled study; treatment outcome; treatment response; aged; middle aged; treatment failure; retrospective studies; major clinical study; overall survival; cancer recurrence; cancer adjuvant therapy; disease free survival; neoadjuvant therapy; cancer staging; follow up; adenocarcinoma; tumor localization; cancer therapy; survival time; clinical evaluation; rectal neoplasms; rectum cancer; rectum resection; rectal cancer; complete clinical response; nonoperative management
Journal Title: Annals of Surgery
Volume: 256
Issue: 6
ISSN: 0003-4932
Publisher: Lippincott Williams & Wilkins  
Date Published: 2012-12-01
Start Page: 965
End Page: 972
Language: English
DOI: 10.1097/SLA.0b013e3182759f1c
PROVIDER: scopus
PUBMED: 23154394
Notes: --- - "Export Date: 2 January 2013" - "CODEN: ANSUA" - "Source: Scopus"
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MSK Authors
  1. Leonard B Saltz
    599 Saltz
  2. Philip B Paty
    373 Paty
  3. Karyn A Goodman
    245 Goodman
  4. Jose Guillem
    373 Guillem
  5. Martin R Weiser
    346 Weiser
  6. Jeannine Alberts Ruby
    8 Ruby
  7. James Dominic Smith
    13 Smith
  8. Garrett Nash
    136 Nash
  9. Larissa Temple
    179 Temple