AIM: To evaluate the long-term results of conventional chemoradiotherapy and laparoscopic mesorectal excision in rectal adenocarcinoma patients without adjuvant therapy. METHODS: Patients with biopsy-proven adenocarcinoma of the rectum staged cT3-T4 by endoscopic ultrasound or magnetic resonance imaging received neoadjuvant continuous infusion of 5-fluorouracil for five weeks and concomitant radiotherapy. Laparoscopic surgery was planned after 5-8 wk. Patients diagnosed with ypT0N0 stage cancer were not treated with adjuvant therapy according to the protocol. Patients with ypT1-2N0 or ypT3-4 or N+ were offered 5-fluorouracil-based adjuvant treatment on an individual basis. An external cohort was used as a reference for the findings. RESULTS: One hundred and seventy six patients were treated with induction chemoradiotherapy and 170 underwent total mesorectal excision. Cancer staging of ypT0N0 was achieved in 26/170 (15.3%) patients. After a median follow-up of 58.3 mo, patients with ypT0N0 had five-year disease-free and overall survival rates of 96% (95%CI: 77-99) and 100%, respectively. We provide evidence about the natural history of patients with localized rectal cancer achieving a complete response after preoperative chemoradiation. The inherent good prognosis of these patients will have implications for clinical trial design and care of patients. CONCLUSION: Withholding adjuvant chemotherapy after complete response following standard neoadjuvant chemoradiotherapy and laparoscopic mesorectal excision might be safe within an experienced multidisciplinary team.
AIM: To evaluate the long-term results of conventional chemoradiotherapy and laparoscopic mesorectal excision in rectal adenocarcinomapatients without adjuvant therapy. METHODS:Patients with biopsy-proven adenocarcinoma of the rectum staged cT3-T4 by endoscopic ultrasound or magnetic resonance imaging received neoadjuvant continuous infusion of 5-fluorouracil for five weeks and concomitant radiotherapy. Laparoscopic surgery was planned after 5-8 wk. Patients diagnosed with ypT0N0 stage cancer were not treated with adjuvant therapy according to the protocol. Patients with ypT1-2N0 or ypT3-4 or N+ were offered 5-fluorouracil-based adjuvant treatment on an individual basis. An external cohort was used as a reference for the findings. RESULTS: One hundred and seventy six patients were treated with induction chemoradiotherapy and 170 underwent total mesorectal excision. Cancer staging of ypT0N0 was achieved in 26/170 (15.3%) patients. After a median follow-up of 58.3 mo, patients with ypT0N0 had five-year disease-free and overall survival rates of 96% (95%CI: 77-99) and 100%, respectively. We provide evidence about the natural history of patients with localized rectal cancer achieving a complete response after preoperative chemoradiation. The inherent good prognosis of these patients will have implications for clinical trial design and care of patients. CONCLUSION: Withholding adjuvant chemotherapy after complete response following standard neoadjuvant chemoradiotherapy and laparoscopic mesorectal excision might be safe within an experienced multidisciplinary team.
Authors: N A Janjan; C N Crane; B W Feig; K Cleary; R Dubrow; S A Curley; L M Ellis; J Vauthey; R Lenzi; P Lynch; R Wolff; T Brown; R Pazdur; J Abbruzzese; P M Hoff; P Allen; B Brown; J Skibber Journal: Int J Radiat Oncol Biol Phys Date: 2000-06-01 Impact factor: 7.038
Authors: Rolf Sauer; Heinz Becker; Werner Hohenberger; Claus Rödel; Christian Wittekind; Rainer Fietkau; Peter Martus; Jörg Tschmelitsch; Eva Hager; Clemens F Hess; Johann-H Karstens; Torsten Liersch; Heinz Schmidberger; Rudolf Raab Journal: N Engl J Med Date: 2004-10-21 Impact factor: 91.245
Authors: M C Kaminsky-Forrett; T Conroy; E Luporsi; D Peiffert; M Lapeyre; P Boissel; F Guillemin; P Bey Journal: Int J Radiat Oncol Biol Phys Date: 1998-12-01 Impact factor: 7.038
Authors: Vincenzo Valentini; Ruud G P M van Stiphout; Guido Lammering; Maria Antonietta Gambacorta; Maria Cristina Barba; Marek Bebenek; Franck Bonnetain; Jean-Francois Bosset; Krzysztof Bujko; Luca Cionini; Jean-Pierre Gerard; Claus Rödel; Aldo Sainato; Rolf Sauer; Bruce D Minsky; Laurence Collette; Philippe Lambin Journal: J Clin Oncol Date: 2011-07-11 Impact factor: 44.544
Authors: Ralf-Dieter Hofheinz; Frederik Wenz; Stefan Post; Axel Matzdorff; Stephan Laechelt; Jörg T Hartmann; Lothar Müller; Hartmut Link; Markus Moehler; Erika Kettner; Elisabeth Fritz; Udo Hieber; Hans Walter Lindemann; Martina Grunewald; Stephan Kremers; Christian Constantin; Matthias Hipp; Gernot Hartung; Deniz Gencer; Peter Kienle; Iris Burkholder; Andreas Hochhaus Journal: Lancet Oncol Date: 2012-04-13 Impact factor: 41.316
Authors: M Mohiuddin; M Hayne; W F Regine; N Hanna; P F Hagihara; P McGrath; G M Marks Journal: Int J Radiat Oncol Biol Phys Date: 2000-11-01 Impact factor: 7.038