Fernando Sanchez Loria1, Soledad Iseas2, Juan Manuel O'Connor3, Alejandro Pairola4, Matias Chacon5, Guillermo Mendez6, Mariana Coraglio7, Javier Mariani8, Adriana Dieguez9, Enrique Roca10, Eduardo Huertas11. 1. Surgical Oncology Instituto Alexander Fleming, Buenos Aires, Argentina. Electronic address: fsanchez@intramed.net. 2. Hospital de Gastroenterologia Bonorino Udaondo, Buenos Aires, Argentina. Electronic address: iseassoledad@hotmail.com. 3. Clinical Oncology Instituto Alexander Fleming, Buenos Aires, Argentina. Electronic address: juanmanuel.oconnor@gmail.com. 4. Surgical Oncology Instituto Alexander Fleming, Buenos Aires, Argentina. Electronic address: apairola@yahoo.com. 5. Clinical Oncology Instituto Alexander Fleming, Buenos Aires, Argentina. Electronic address: matiemi@yahoo.com. 6. Hospital de Gastroenterologia Bonorino Udaondo, Buenos Aires, Argentina. Electronic address: mendezdoc@hotmail.com. 7. Hospital de Gastroenterologia Bonorino Udaondo, Buenos Aires, Argentina. Electronic address: mcoraglio@hotmail.com. 8. Statistitian Instituto Alexander Fleming, Buenos Aires, Argentina. Electronic address: ja_mariani@hotmail.com. 9. Imagenologist Diagnostico Medico, Buenos Aires, Argentina. Electronic address: amdieguez@speedy.com.ar. 10. Hospital de Gastroenterologia Bonorino Udaondo, Buenos Aires, Argentina. Electronic address: enlroca@yahoo.com.ar. 11. Surgical Oncology Instituto Alexander Fleming, Buenos Aires, Argentina. Electronic address: huertaseduardo@yahoo.com.ar.
Abstract
BACKGROUND: The non-surgical management in a selected group of rectal cancer patients has shown promising results with adequate follow up. AIMS: describing the results of the non-surgical management in patients with complete clinical response, with a close follow up. METHODS: Between 2006 and 2015, patients with rectal cancer, stages I-III, without metastasis, treated with neoadjuvant CRT/CT, who had clinical complete response were included. CCR was defined through digital palpation, endoscopy-based criteria and MRI. Follow up was set according to institutional guidelines. RESULTS: 68 patients were included. Initial stage was assessed with MRI in 55/68 pts and EUS 11/68. Considering the recurrence risk factors 57.6% (29/68) were T2-3ab N0, 3.3% (2/68) were T4N0, 29% (20/68) were T3-4 N1-2, with 39.7% with positive MRC. Mean distance to the anal margin was 3cm. Chemoradiation included radiotherapy at 50.4cGy, and concurrent capecitabine. In 22% a fluoropirimidine and oxaliplatin-based schema was used as induction therapy. Median follow up was 37.5 months and response assessment time 9 weeks (5-19). Eleven patients recurred, 6 endoluminally, 3 developed mesorectal recurrence, and two distant failure. Five years DFS and OS were 76.3% and 93.8%. CONCLUSIONS: conservative management was feasible with close follow up in leading cancer centres. In this series, DFS and OS were comparable to the data already reported in the literature.
BACKGROUND: The non-surgical management in a selected group of rectal cancerpatients has shown promising results with adequate follow up. AIMS: describing the results of the non-surgical management in patients with complete clinical response, with a close follow up. METHODS: Between 2006 and 2015, patients with rectal cancer, stages I-III, without metastasis, treated with neoadjuvant CRT/CT, who had clinical complete response were included. CCR was defined through digital palpation, endoscopy-based criteria and MRI. Follow up was set according to institutional guidelines. RESULTS: 68 patients were included. Initial stage was assessed with MRI in 55/68 pts and EUS 11/68. Considering the recurrence risk factors 57.6% (29/68) were T2-3ab N0, 3.3% (2/68) were T4N0, 29% (20/68) were T3-4 N1-2, with 39.7% with positive MRC. Mean distance to the anal margin was 3cm. Chemoradiation included radiotherapy at 50.4cGy, and concurrent capecitabine. In 22% a fluoropirimidine and oxaliplatin-based schema was used as induction therapy. Median follow up was 37.5 months and response assessment time 9 weeks (5-19). Eleven patients recurred, 6 endoluminally, 3 developed mesorectal recurrence, and two distant failure. Five years DFS and OS were 76.3% and 93.8%. CONCLUSIONS: conservative management was feasible with close follow up in leading cancer centres. In this series, DFS and OS were comparable to the data already reported in the literature.
Authors: Seong Ho Park; Seung Hyun Cho; Sang Hyun Choi; Jong Keon Jang; Min Ju Kim; Seung Ho Kim; Joon Seok Lim; Sung Kyoung Moon; Ji Hoon Park; Nieun Seo Journal: Korean J Radiol Date: 2020-07 Impact factor: 3.500
Authors: Mariana F Coraglio; Martin A Eleta; Mirta R Kujaruk; Javier H Oviedo; Enrique L Roca; Guillermo A Masciangioli; Guillermo Mendez; Ilma S Iseas Journal: World J Surg Oncol Date: 2020-11-30 Impact factor: 2.754