Non-surgical management of rectal cancer. Series of 68 cases, long follow up in two leading centres in Argentina

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• 作者：Fernando Sanchez Loria^a ; ^{fsanchez@intramed.net" class="auth_mail" title="E-mail the corresponding author} ; Soledad Iseas^d ; ^{iseassoledad@hotmail.com" class="auth_mail" title="E-mail the corresponding author} ; Juan Manuel O&rsquo ; Connor^b ; ^{juanmanuel.oconnor@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Alejandro Pairola^a ; ^{apairola@yahoo.com" class="auth_mail" title="E-mail the corresponding author} ; Matias Chacon^b ; ^{matiemi@yahoo.com" class="auth_mail" title="E-mail the corresponding author} ; Guillermo Mendez^d ; ^{mendezdoc@hotmail.com" class="auth_mail" title="E-mail the corresponding author} ; Mariana Coraglio^d ; ^{mcoraglio@hotmail.com" class="auth_mail" title="E-mail the corresponding author} ; Javier Mariani^c ; ^{ja_mariani@hotmail.com" class="auth_mail" title="E-mail the corresponding author} ; Adriana Dieguez^e ; ^{amdieguez@speedy.com.ar" class="auth_mail" title="E-mail the corresponding author} ; Enrique Roca^d ; ^{enlroca@yahoo.com.ar" class="auth_mail" title="E-mail the corresponding author} ; Eduardo Huertas^a ; ^{huertaseduardo@yahoo.com.ar" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Complete response ; Neoadjuvant chemoradiation ; Organ preserving ; Rectal cancer
• 刊名：Digestive and Liver Disease
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：48
• 期：11
• 页码：1372-1377
• 全文大小：601 K

文摘

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 3 cm. Chemoradiation included radiotherapy at 50.4 cGy, 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.