Long-Term Outcome of Patients with Complete Pathologic Response after Neoadjuvant Chemoradiation for cT3 Rectal Cancer: Implications for Local Excision Surgical Strategies

详细信息    查看全文

• 作者：Claudio Belluco MD ; PhD (1)
  Antonino De Paoli MD (2)
  Vincenzo Canzonieri MD (3)
  Roberto Sigon MD (1)
  Mara Fornasarig MD (4)
  Angela Buonadonna MD (5)
  Giovanni Boz MD (2)
  Roberto Innocente MD (2)
  Tiziana Perin MD (3)
  Marta Cossaro MD (1)
  Jerry Polesel ScD (6)
  Francesco De Marchi MD (1)
  
• 刊名：Annals of Surgical Oncology
• 出版年：2011
• 出版时间：December 2011
• 年：2011
• 卷：18
• 期：13
• 页码：3686-3693
• 全文大小：457KB
• 参考文献：1. Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. / N Engl J Med. 2004;351:1731-0. CrossRef
  2. Bosset JF, Collette L, Calais G, et al. Chemotherapy with preoperative radiotherapy in rectal cancer. / N Engl J Med. 2006;355:1114-3. CrossRef
  3. Gérard JP, Conroy T, Bonnetain F, et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3- rectal cancer: results of FFCD 9203. / J Clin Oncol. 2006;24:4620-. CrossRef
  4. Bujko K, Nowacki MP, Nasierowska-Guttmejer A, et al. Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. / Br J Surg. 2006;93:1215-3. CrossRef
  5. Valentini V, Aristei C, Glimelius B, et al. Multidisciplinary rectal cancer management: 2nd European Rectal Cancer Consensus Conference (EURECA-CC2). / Radiother Oncol. 2008;87:449-4. CrossRef
  6. Sanghera P, Wong DW, McConkey CC, Geh JI, Hartley A. Chemoradiotherapy for rectal cancer: an updated analysis of factors affecting pathological response. / Clin Oncol (R Coll Radiol). 2008;20:176-3. CrossRef
  7. Maas M, Nelemans PJ, Valentini V, et al. Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data. / Lancet Oncol. 2010;11:835-4. CrossRef
  8. Stipa F, Chessin DB, Shia J, et al. A pathologic complete response of rectal cancer to preoperative combined-modality therapy results in improved oncological outcome compared with those who achieve no downstaging on the basis of preoperative endorectal ultrasonography. / Ann Surg Oncol. 2006;13:1047-3. CrossRef
  9. Capirci C, Valentini V, Cionini L, et al. Prognostic value of pathologic complete response after neoadjuvant therapy in locally advanced rectal cancer: long-term analysis of 566 ypCR patients. / Int J Radiat Oncol Biol Phys. 2008;72:99-07. CrossRef
  10. de Campos-Lobato LF, Stocchi L, da Luz Moreira A et al. Pathologic complete response after neoadjuvant treatment for rectal cancer decreases distant recurrence and could eradicate local recurrence. / Ann Surg Oncol. 2011;18:1590-. CrossRef
  11. Wolthuis AM, Penninckx F, Haustermans K, Ectors N, Van Cutsem E, D’Hoore A. Outcome standards for an organ preservation strategy in stage II and III rectal adenocarcinoma after neoadjuvant chemoradiation. / Ann Surg Oncol. 2011;18:684-0. CrossRef
  12. R?del C, Martus P, Papadoupolos T, et al. Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. / J Clin Oncol. 2005;23:8688-6. CrossRef
  13. Coco C, Manno A, Mattana C, et al. The role of local excision in rectal cancer after complete response to neoadjuvant treatment. / Surg Oncol. 2007;16(Suppl 1):S101-. CrossRef
  14. Caricato M, Ausania F, De Dominicis E, et al. Tumor regression in mesorectal lymphnodes after neoadjuvant chemoradiation for rectal cancer. / Eur J Surg Oncol. 2007;33:724-. CrossRef
  15. Hughes R, Glynne-Jones R, Grainger J, et al. Can pathological complete response in the primary tumour following pre operative pelvic chemoradiotherapy for T3–T4 rectal cancer predict for sterilisation of pelvic lymph nodes, a low risk of local recurrence and the appropriateness of local excision? / Int J Colorectal Dis. 2006;21:11-. CrossRef
  16. Kundel Y, Brenner R, Purim O, et al. Is local excision after complete pathological response to neoadjuvant chemoradiation for rectal cancer an acceptable treatment option? / Dis Colon Rectum. 2010;53:1624-1. CrossRef
  17. Pucciarelli S, Capirci C, Emanuele U, et al. Relationship between pathologic T-stage and nodal metastasis after preoperative chemoradiotherapy for locally advanced rectal cancer. / Ann Surg Oncol. 2005;12:111-. CrossRef
  18. Bedrosian I, Rodriguez-Bigas MA, Feig B, et al. Predicting the node-negative mesorectum after preoperative chemoradiation for locally advanced rectal carcinoma. / J Gastrointest Surg. 2004;8:56-2. CrossRef
  19. Callender GG, Das P, Rodriguez-Bigas MA, et al. Local excision after preoperative chemoradiation results in an equivalent outcome to total mesorectal excision in selected patients with T3 rectal cancer. / Ann Surg Oncol. 2010;17:441-. CrossRef
  20. Guerrieri M, Baldarelli M, Organetti L, et al. Transanal endoscopic microsurgery for the treatment of selected patients with distal rectal cancer: 15?years experience. / Surg Endosc. 2008;22:2030-. CrossRef
  21. Nair RM, Siegel EM, Chen DT, et al. Long-term results of transanal excision after neoadjuvant chemoradiation for T2 and T3 adenocarcinomas of the rectum. / J Gastrointest Surg. 2008;12:1797-05. CrossRef
  22. Borschitz T, Wachtlin D, M?hler M, Schmidberger H, Junginger T. Neoadjuvant chemoradiation and local excision for T2- rectal cancer. / Ann Surg Oncol. 2008;15:712-0. CrossRef
  23. Bonnen M, Crane C, Vauthey JN, et al. Long-term results using local excision after preoperative chemoradiation among selected T3 rectal cancer patients. / Int J Radiat Oncol Biol Phys. 2004;60:1098-05. CrossRef
  24. Ruo L, Guillem JG, Minsky BD, Quan SH, Paty PB, Cohen AM. Preoperative radiation with or without chemotherapy and full-thickness transanal excision for selected T2 and T3 distal rectal cancers. / Int J Colorectal Dis. 2002;17:54-. CrossRef
  25. Kim CJ, Yeatman TJ, Coppola D, et al. Local excision of T2 and T3 rectal cancers after downstaging chemoradiation. / Ann Surg. 2001;234:352-. CrossRef
  26. Schell SR, Zlotecki RA, Mendenhall WM, Marsh RW, Vauthey JN, Copeland EM 3rd. Transanal excision of locally advanced rectal cancers downstaged using neoadjuvant chemoradiotherapy. / J Am Coll Surg. 2002;194:584-0. CrossRef
  27. Habr-Gama A, Perez RO, Nadalin W, et al. Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results. / Ann Surg. 2004;240:711-.
  28. Habr-Gama A, Perez R, Proscurshim I, Gama-Rodrigues J. Complete clinical response after neoadjuvant chemoradiation for distal rectal cancer. / Surg Oncol Clin N Am. 2010;19:829-5. CrossRef
  29. O’Neill BD, Brown G, Heald RJ, Cunningham D, Tait DM. Non-operative treatment after neoadjuvant chemoradiotherapy for rectal cancer. / Lancet Oncol. 2007;8:625-3. CrossRef
  30. Cionini L, Sainato A, De Paoli A, et al. Final results of randomized trial on adjuvant chemotherapy after preoperative chemoradiation in rectal cancer. / Radiother Oncol. In press.
  31. Gambacorta MA, Valentini V, Morganti AG, et al. Chemoradiation with raltitrexed (Tomudex) in preoperative treatment of stage II–III resectable rectal cancer: a phase II study. / Int J Radiat Oncol Biol Phys. 2004;60:130-. CrossRef
  32. De Paoli A, Chiara S, Luppi G, et al. Capecitabine in combination with preoperative radiation therapy in locally advanced, resectable, rectal cancer: a multicentric phase II study. / Ann Oncol. 2006;17:246-1. CrossRef
  33. Valentini V, De Paoli A, Gambacorta MA, et al. Infusional 5-fluorouracil and ZD1839 (Gefitinib-Iressa) in combination with preoperative radiotherapy in patients with locally advanced rectal cancer: a phase I and II trial (1839IL/0092). / Int J Radiat Oncol Biol Phys. 2008;72:644-. CrossRef
  34. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A III. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.
  35. Quirke P, Dixon MF. The prediction of local recurrence of rectal adenocarcinoma by histopathological examination. / Int J Colorectal Dis. 1998;3:127-1. CrossRef
  36. Kaplan EL, Meier P. Non-parametric estimation from incomplete observations. / J Am Stat Assoc. 1958;53:457-1. CrossRef
  37. Cox DR. Regression model and life-tables. / J R Stat Soc B. 1972;34:178-20.
  38. Collette L, Bosset JF, den Dulk M, et al. European Organisation for Research and Treatment of Cancer Radiation Oncology Group. Patients with curative resection of cT3- rectal cancer after preoperative radiotherapy or radiochemotherapy: does anybody benefit from adjuvant fluorouracil-based chemotherapy? A trial of the European Organisation for Research and Treatment of Cancer Radiation Oncology Group. / J Clin Oncol. 2007;25:4379-6. CrossRef
  39. Read TE, Andujar JE, Caushaj FP, et al. Neoadjuvant therapy for rectal cancer: histologic response of the primary tumor predicts nodal status. / Dis Colon Rectum. 2004;47:825-1. CrossRef
  40. Guillem JG, Díaz-González JA, Minsky BD, et al. cT3N0 rectal cancer: potential overtreatment with preoperative chemoradiotherapy is warranted. / J Clin Oncol. 2008;26:368-3. CrossRef
  
• 作者单位：Claudio Belluco MD, PhD (1)
  Antonino De Paoli MD (2)
  Vincenzo Canzonieri MD (3)
  Roberto Sigon MD (1)
  Mara Fornasarig MD (4)
  Angela Buonadonna MD (5)
  Giovanni Boz MD (2)
  Roberto Innocente MD (2)
  Tiziana Perin MD (3)
  Marta Cossaro MD (1)
  Jerry Polesel ScD (6)
  Francesco De Marchi MD (1)
  
  1. Department of Surgical Oncology, CRO—IRCCS, National Cancer Institute, Aviano, Italy
  2. Department of Radiotherapy, CRO—IRCCS, National Cancer Institute, Aviano, Italy
  3. Department of Pathology, CRO—IRCCS, National Cancer Institute, Aviano, Italy
  4. Department of Gastroenterology, CRO—IRCCS, National Cancer Institute, Aviano, Italy
  5. Department of Medical Oncology, CRO—IRCCS, National Cancer Institute, Aviano, Italy
  6. Department of Epidemiology, CRO—IRCCS, National Cancer Institute, Aviano, Italy
  

文摘

Background Neoadjuvant chemoradiotherapy (CRT) followed by radical surgery including total mesorectal excision (TME) is standard treatment in patients with locally advanced rectal cancer. Emerging data indicate that patients with complete pathologic response (ypCR) after CRT have favorable outcome, suggesting the possibility of less invasive surgical treatment. We analyzed long-term outcome of cT3 rectal cancer treated by neoadjuvant CRT in relation to ypCR and type of surgery. Methods The study population comprised 139 patients (93 men, 46 women; median age 62?years) with cT3N0-M0 mid and distal rectal adenocarcinoma treated by CRT and surgery (110 TME and 29 local excision) at our institution between 1996 and 2008. At pathology, ypCR was defined as no residual cancer cells in the primary tumor. Results Tumors of 42 patients (30.2%) were classified as ypCR. After a median follow-up of 55.4?months, comparing patients with ypCR to patients with no ypCR, 5-year disease-specific survival was 95.8% versus 78.0% (P?=?0.004), and 5-year disease-free survival was 90.1% vs. 64.0% (P?=?0.004). In patients with ypCR, no statistically significant outcome difference was observed between TME and local excision. In patients treated by local excision, comparing patients with ypCR to patients with no ypCR, 5-year disease-free survival was 100% vs. 65.5% (P?=?0.024), and 5-year local recurrence-free survival was 92.9% vs. 66.7% (P?=?0.047). Conclusions With retrospective analysis limitations, our data confirm favorable long-term outcome of cT3 rectal cancer with ypCR after CRT and warrant clinical trials exploring local excision surgical strategies.