Organ Preservation in cT2N0 Rectal Cancer After Neoadjuvant Chemoradiation Therapy: The Impact of Radiation Therapy Dose-escalation and Consolidation Chemotherapy. Issue 1 (January 2019)

• Record Type: Journal Article
• Authors: Habr-Gama, Angelita; São Julião, Guilherme Pagin; Vailati, Bruna Borba; Sabbaga, Jorge; Aguilar, Patricia Bailão; Fernandez, Laura Melina; Araújo, Sergio Eduardo Alonso; Perez, Rodrigo Oliva
• Is Part Of: Annals of surgery. Volume 269:Issue 1(2019)
• Publication Date: 2019-01
• Subjects: chemoradiation -- neoadjuvant -- organ preservation -- rectal cancer -- watch and wait; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000002447
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Objective: To demonstrate the difference in organ-preservation rates and avoidance of definitive surgery among cT2N0 rectal cancer patients undergoing 2 different chemoradiation (CRT) regimens. Background: Patients with cT2N0 rectal cancer are more likely to develop complete response to neoadjuvant CRT. Organ preservation has been considered an alternative treatment strategy for selected patients. Radiation dose-escalation and consolidation chemotherapy have been associated with increased rates of response and may improve chances of organ preservation among these patients. Methods: Patients with distal and nonmetastatic cT2N0 rectal cancer managed by neoadjuvant CRT were retrospectively reviewed. Patients undergoing standard CRT (50.4 Gy and 2 cycles of 5-FU-based chemotherapy) were compared with those undergoing extended CRT (54 Gy and 6 cycles of 5-FU-based chemotherapy). Patients were assessed for tumor response at 8 to 10 weeks. Patients with complete clinical response (cCR) underwent organ-preservation strategy ("Watch and Wait"). Patients were referred to salvage surgery in the event of local recurrence during follow-up. Results: Thirty-five patients underwent standard and 46 patients extended CRT. Patients undergoing extended CRT were more likely to undergo organ preservation and avoid definitive surgical resection at 5years (67% vs 30%; P = 0.001). After development of a cCR, surgery-free survival is similar between extended and standard CRT groups at 5 years (78% vs 56%; P = 0.12). Conclusions: Dose-escalation and consolidation chemotherapy leads to increased long-term organ-preservation rates among cT2N0 rectal cancer. After achievement of a cCR, the risk for local recurrence and need for salvage surgery is similar, irrespective of the CRT regimen. Abstract : Supplemental Digital Content is available in the text