Maysoon Gamaleldin1, James M Church1, Luca Stocchi1, Mathew Kalady1, David Liska1, Emre Gorgun2. 1. Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA. 2. Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA. Electronic address: gorgune@ccf.org.
Abstract
BACKGROUND: Patients with locally advanced rectal cancer (LARC) receiving neoadjuvant chemoradiation (nCRT) can have a complete pathologic response (pCR), and are given postoperative adjuvant chemotherapy (ACT). METHODS: A prospectively maintained outcomes database was queried for patients who had pCR to nCRT for LARC from 2000 to 2012. Local recurrence and survival were analyzed according to whether patients received ACT. RESULTS: We identified 139 patients and excluded 9 due to lack of follow-up. Mean age was 58.9 ± 11.8 years. 83 patients (63.8%) did not receive ACT (Group A) and 47 (36.2%) did (Group B). Mean follow-up was 5.7 ± 3 and 5.6 ± 3.5 years for Groups A and B respectively (p = 0.51). Groups were comparable in age, gender, tumor differentiation, and clinical staging. There were no differences in oncological outcomes. CONCLUSION: Avoiding routine use of ACT in patients with a pCR may be considered. Further justification of this approach warrants prospective randomized studies.
BACKGROUND:Patients with locally advanced rectal cancer (LARC) receiving neoadjuvant chemoradiation (nCRT) can have a complete pathologic response (pCR), and are given postoperative adjuvant chemotherapy (ACT). METHODS: A prospectively maintained outcomes database was queried for patients who had pCR to nCRT for LARC from 2000 to 2012. Local recurrence and survival were analyzed according to whether patients received ACT. RESULTS: We identified 139 patients and excluded 9 due to lack of follow-up. Mean age was 58.9 ± 11.8 years. 83 patients (63.8%) did not receive ACT (Group A) and 47 (36.2%) did (Group B). Mean follow-up was 5.7 ± 3 and 5.6 ± 3.5 years for Groups A and B respectively (p = 0.51). Groups were comparable in age, gender, tumor differentiation, and clinical staging. There were no differences in oncological outcomes. CONCLUSION: Avoiding routine use of ACT in patients with a pCR may be considered. Further justification of this approach warrants prospective randomized studies.
Authors: Anita Nguyen; David R James; Eric J Dozois; Scott R Kelley; Kellie L Mathis Journal: J Gastrointest Surg Date: 2019-02-06 Impact factor: 3.452
Authors: Fahima Dossa; Sergio A Acuna; Aaron S Rickles; Mariana Berho; Steven D Wexner; Fayez A Quereshy; Nancy N Baxter; Sami A Chadi Journal: JAMA Oncol Date: 2018-07-01 Impact factor: 31.777