Are We Predicting Disease Progress of the Rectal Cancer Patients without Surgery after Neoadjuvant Chemoradiotherapy?.
- Author:
Bo Young OH
1
;
Jung Wook HUH
;
Woo Yong LEE
;
Yoon Ah PARK
;
Yong Beom CHO
;
Seong Hyeon YUN
;
Hee Cheol KIM
;
Ho Kyung CHUN
Author Information
- Publication Type:Original Article
- Keywords: Rectal neoplasms; Neoadjuvant therapy; Chemoradiotherapy; Surgery
- MeSH: Chemoradiotherapy*; Disease Progression; Disease-Free Survival; Humans; Neoadjuvant Therapy; Propensity Score; Rectal Neoplasms*; Retrospective Studies; Salvage Therapy
- From:Cancer Research and Treatment 2018;50(3):634-645
- CountryRepublic of Korea
- Language:English
- Abstract: PURPOSE: There are patients who do not undergo surgery, regardless of tumor response for neoadjuvant chemoradiotherapy (nCRT) in rectal cancer. However, there have been few reports focused on how oncologic outcomes are worse in these patients. We sought to investigate oncologic outcomes for these non-operated patients with rectal cancer after nCRT. MATERIALS AND METHODS: A total of 1,063 records of patients with rectal cancer who were treated with nCRT from January 2002 to December 2013 were retrospectively reviewed. We categorized patients into the non-operated group (n=77), transanal local excision (TLE) group (n=54), ortotal mesorectal excision (TME) group (n=932) and compared each group using propensity score matching. RESULTS: In the non-operated group, the most common reason for no surgery was patient refusal (n=64). Eleven patients were considered to have achieve clinical complete response (cCR), which was an independent prognostic factor of progression-free survival (p=0.045). In patients with disease progression in the non-operated group, the overall survival did not improved according to salvage treatments (p=0.451). The non-operated group showed worse survivals compared to the TLE or TME group before and after matching (p < 0.001). This finding was also noted in the analysis of survival only in patients with cCR. CONCLUSION: In this study, non-operated patients did not secure oncologic safety regardless of cCR after nCRT. Our results suggest that a non-operative management must be carefully considered even if cCR is achieved.
