Ann Coloproctol.  2019 Apr;35(2):65-71. 10.3393/ac.2019.03.17.

Oncologic Outcomes of Organ Preserving Approaches in Patients With Rectal Cancer Treated With Preoperative Chemoradiotherapy

• Park IJ
• Lee JL
• Yoon YS
• Kim CW
• Lim SB
• Yu CS
• Kim JC

• KMID: 2448266
• DOI: http://doi.org/10.3393/ac.2019.03.17

Abstract

PURPOSE
We evaluated the oncologic outcomes of organ-preserving strategies in patients with rectal cancer treated with preoperative chemoradiotherapy (PCRT).
METHODS
Between January 2008 and January 2013, 74 patients who underwent wait-and-watch (WW) (n = 42) and local excision (LE) (n = 32) were enrolled. Organ-preserving strategies were determined based on a combination of magnetic resonance imaging, sigmoidoscopy, and physical examination 4-6 weeks after completion of PCRT. The rectum sparing rate, 5-year recurrence-free survival (RFS), and overall survival (OS) were evaluated.
RESULTS
The rectum was more frequently spared in the LE (100% vs. 87.5%, P = 0.018) at last follow-up. Recurrence occurred in 9 (28.1%) WW and 7 (16.7%) LE (P = 0.169). In the WW, 7 patients had only luminal regrowth and 2 had combined lung metastasis. In the LE, 2 (4.8%) had local recurrence only, 4 patients had distant metastasis, and 1 patient had local and distant metastasis. Among 13 patients who indicated salvage surgery (WW, n = 7; LE, n = 11), all in the WW received but all of LE refused salvage surgery (P = 0.048). The 5-year OS and 5-year RFS in overall patients was 92.7% and 76.9%, respectively, and were not different between WW and LE (P = 0.725, P = 0.129).
CONCLUSION
WW and LE were comparable in terms of 5-year OS and RFS. In the LE group, salvage treatment was performed much less among indicated patients. Therefore, methods to improve the oncologic outcomes of patients indicated for salvage treatment should be considered before local excision.

Keyword

Rectal neoplasms; Organ preservation; Watch-and-wait; Treatment outcome

MeSH Terms

Chemoradiotherapy*
Follow-Up Studies
Humans
Lung
Magnetic Resonance Imaging
Neoplasm Metastasis
Organ Preservation
Phenobarbital
Physical Examination
Rectal Neoplasms*
Rectum
Recurrence
Salvage Therapy
Sigmoidoscopy
Treatment Outcome
Phenobarbital