Ann Surg Treat Res.  2019 Feb;96(2):78-85. 10.4174/astr.2019.96.2.78.

Does total regression of primary rectal cancer after preoperative chemoradiotherapy represent “no tumor” status?

• Jeong SA
• Park IJ
• Hong SM
• Bong JW
• Choi HY
• Seo JH
• Kim HE
• Lim SB
• Yu CS
• Kim JC

• KMID: 2433944
• DOI: http://doi.org/10.4174/astr.2019.96.2.78

Abstract

PURPOSE
Insistence that total regression of primary tumor would not represent long-term oncologic outcomes has been raised. Therefore, this study aimed to evaluate the outcomes of these patients after preoperative chemoradiotherapy (PCRT) and radical surgery and to evaluate the associated risk factors.
METHODS
We included 189 patients with rectal cancer who showed total regression of the primary tumor after PCRT, followed by radical resection, between 2001 and 2012. Recurrence-free survival (RFS) was calculated using the Kaplan-Meier method, and the results were compared with 77 patients with Tis rectal cancer who received only radical resection. Factors associated with RFS were evaluated using Cox regression analysis.
RESULTS
Sphincter-saving resection was performed for 146 patients (77.2%). Adjuvant chemotherapy was administered to 168 patients (88.9%). During the follow-up period, recurrence occurred in 17 patients (9%). The 5-year RFS was 91.3%, which was significantly lower than that of patients with Tis rectal cancer without PCRT (P = 0.005). In univariate analysis, preoperative CEA and histologic differentiation were associated with RFS. However, no factors were found to be associated with RFS.
CONCLUSION
RFS was lower in patients with total regression of primary rectal cancer after PCRT than in those with Tis rectal cancer without PCRT, and it would not be considered as the same entity with early rectal cancer or "disappeared tumor" status.

Keyword

Rectal neoplasm; Chemoradiotherapy; Total regression; Recurrence

MeSH Terms

Chemoradiotherapy*
Chemotherapy, Adjuvant
Follow-Up Studies
Humans
Methods
Rectal Neoplasms*
Recurrence
Risk Factors

Figure

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  Fig. 1 CONSORT (consolidated standards for reporting of trials) diagram.

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  Fig. 2 Recurrence-free survival (RFS) in patients with total regression of primary tumor after preoperative chemoradiotherapy (PCRT), and those with Tis rectal cancer without PCRT (No PCRT).

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