Oncologic Outcomes of Organ Preserving Approaches in Patients With Rectal Cancer Treated With Preoperative Chemoradiotherapy
- Author:
In Ja PARK
1
;
Jong Lyul LEE
;
Yong Sik YOON
;
Chan Wook KIM
;
Seok Byung LIM
;
Chang Sik YU
;
Jin Cheon KIM
Author Information
- Publication Type:Original Article
- Keywords: Rectal neoplasms; Organ preservation; Watch-and-wait; Treatment outcome
- MeSH: 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
- From:Annals of Coloproctology 2019;35(2):65-71
- CountryRepublic of Korea
- Language:English
- 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.
