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Is Local Excision After Complete Pathological Response to Neoadjuvant Chemoradiation for Rectal Cancer an Acceptable Treatment Option?

Kundel, Yulia M.D.1,2; Brenner, Ronen M.D.1; Purim, Ofer M.D.1,2; Peled, Nir M.D.1,2; Idelevich, Efraim M.D.3; Fenig, Eyal M.D.1,2; Sulkes, Aaron M.D.1,2; Brenner, Baruch M.D.1,2

Diseases of the Colon & Rectum:
doi: 10.1007/DCR.0b013e3181f5b64d
Original Contribution
Abstract

PURPOSE: The role of local excision in patients with good histological response to neoadjuvant chemoradiation for locally advanced rectal cancer is unclear, mainly because of possible regional nodal involvement. This study aims to evaluate the correlation between pathological T and N stages following neoadjuvant chemoradiation for locally advanced rectal cancer and the outcome of patients with mural pathological complete response undergoing local excision.

METHODS: This investigation was conducted as a retrospective analysis. Between January 1997 and December 2007, 320 patients with T3 to 4Nx, TxN+ or distal (≤6 cm from the anus) T2N0 rectal cancer underwent neoadjuvant concurrent chemoradiation followed by surgery. Radiotherapy was standard and chemotherapy consisted of common fluoropyrimidine-based regimens.

RESULTS: After chemoradiation, 93% patients had radical surgery, 6% had local excision, and 3% did not have surgery. In the 291 patients undergoing radical surgery, the pathological T stage correlated with the N stage (P = .036). We compared the outcome of patients with mural complete pathological response (n = 37) who underwent radical surgery (group I) and those (n = 14) who had local excision only (group II). With a median follow-up of 48 months, 4 patients in group I had a recurrence and none in group II had a recurrence; one patient died in group I and none died in group II. Disease-free survival, pelvic recurrence-free survival, and overall survival rates were similar in both groups.

CONCLUSION: In this retrospective study, nodal metastases were rare in patients with mural complete pathological response following neoadjuvant chemoradiation (3%), and local excision did not compromise their outcome. Therefore, local excision may be an acceptable option in these patients.

Author Information

1Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tikva, Israel

2Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Tel-Aviv, Israel

3Institute of Oncology, Kaplan Medical Center and Faculty of Medicine, Hebrew University, Jerusalem, Israel

Financial Disclosure: None reported.

Correspondence: Baruch Brenner, M.D., Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petach Tikva 49100, Israel. E-mail: brennerb@clalit.org.il

© The ASCRS 2010