Outcome of Local Excision Following Preoperative Chemoradiotherapy for Clinically T2 Distal Rectal Cancer: A Multicenter Retrospective Study (KROG 12-06)
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PurposeThe aim of this study was to examine the clinical implications of a pathologically completeresponse after neoadjuvant chemoradiotherapy (CRT) followed by local excisionfor patients with cT2 rectal cancer who refused radical surgery. Materials and MethodsSeventeen patients with cT2 primary rectal cancer within 6 cm from the anal vergewho received neoadjuvant CRT and local excision because of patient refusal of radicalsurgery or poor performance status were included. Two patients had clinical involvementof a regional lymph node. Preoperative radiotherapy was delivered to the wholepelvis at a dose of 44 to 50.4 Gy in 22 to 28 fractions. All patients underwent transanalexcision and eight patients (47%) received postoperative chemotherapy. ResultsTen patients (59%) achieved ypT0. At a median follow-up period of 75 months (range,22 to 126 months), four (24%) patients developed recurrence (two locoregional andtwo distant). The 5-year disease-free survival of all patients was 82%, and was higherin patients with ypT0 (90%) than in patients with ypT1-2 (69%, p=0.1643). Decreaseddisease-free survival was also observed in patients receiving capecitabine comparedwith 5-fluorouracil (54% vs. 100%, p=0.0298). ConclusionLocal excision could be a feasible alternative to radical surgery in patients with ypT0after neoadjuvant CRT for cT2 distal rectal cancer without further radical surgery.
Abstract
PurposeThe aim of this study was to examine the clinical implications of a pathologically completeresponse after neoadjuvant chemoradiotherapy (CRT) followed by local excisionfor patients with cT2 rectal cancer who refused radical surgery. Materials and MethodsSeventeen patients with cT2 primary rectal cancer within 6 cm from the anal vergewho received neoadjuvant CRT and local excision because of patient refusal of radicalsurgery or poor performance status were included. Two patients had clinical involvementof a regional lymph node. Preoperative radiotherapy was delivered to the wholepelvis at a dose of 44 to 50.4 Gy in 22 to 28 fractions. All patients underwent transanalexcision and eight patients (47%) received postoperative chemotherapy. ResultsTen patients (59%) achieved ypT0. At a median follow-up period of 75 months (range,22 to 126 months), four (24%) patients developed recurrence (two locoregional andtwo distant). The 5-year disease-free survival of all patients was 82%, and was higherin patients with ypT0 (90%) than in patients with ypT1-2 (69%, p=0.1643). Decreaseddisease-free survival was also observed in patients receiving capecitabine comparedwith 5-fluorouracil (54% vs. 100%, p=0.0298). ConclusionLocal excision could be a feasible alternative to radical surgery in patients with ypT0after neoadjuvant CRT for cT2 distal rectal cancer without further radical surgery.
참고문헌 (25)
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