alexa Neoadjuvant chemoradiation and local excision for T2-3 rectal cancer


Journal of Blood & Lymph

Author(s): Borschitz T, Wachtlin D

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Search term Clear input Advanced Help NCBI will be testing https on public web servers from 1:00-4:00 PM EDT (17:00-20:00 UTC) on Monday, October 24. You may experience problems with NCBI services, especially file downloads, during that time. Please plan accordingly. Read more. Result Filters Format: Abstract Send to Ann Surg Oncol. 2008 Mar;15(3):712-20. Epub 2007 Dec 28. Neoadjuvant chemoradiation and local excision for T2-3 rectal cancer. Borschitz T1, Wachtlin D, Möhler M, Schmidberger H, Junginger T. Author information Abstract BACKGROUND: Local excision (LE) of T1 low-risk (G1-2/L0/V0) rectal cancer is an established approach with local recurrence (LR) rates of approximately 5%, whereas LE of > or = T2 high-risk tumors or inadequate resections (R1/RX/R < or = 1 mm) showed high recurrence rates. Because of the favorable results after neoadjuvant chemoradiotherapy (nCRT) and radical surgery of disease that completely responds (CR) with almost absent LR even of T3-4 tumors, an extension of the indication for LE is controversially discussed, and therefore, we assessed this therapeutic option. METHODS: Including our own data, seven studies about LE after nCRT of cT2-3 tumors (n = 237) were analyzed after a PubMed search for cT categories, tumor height, nCRT regimens, schedule and technique of surgery, complications, freedom of stoma, response rates (ypT0-3), length of follow-up, LR, and metastases. RESULTS: Subgroups that we formed (retrospective vs. prospective/retractor vs. transanal endoscopic microsurgery) showed differences in the distribution of cT categories. However, neither the studies we considered nor our own patients showed LR in CR (ypT0). In addition, patients with ypT1 tumor consistently showed low LR rates of 2% (range, 0%-6%), whereas in ypT2 findings, less favorable LR rates of 6% to 20% were observed, and disease that did not respond to therapy (ypT3) displayed LR rates in up to 42%. CONCLUSIONS: Despite of a highly selected patient collective, an extended indication for LE of cT2-3 rectal cancer after nCRT may be considered. The strongest prognostic factors were a CR (ypT0) or responses on submucosa level (ypT1). These first results will have to be confirmed in a prospective trial with an appropriate sample size to ensure high statistical power.

This article was published in Ann Surg Oncol. 2008 and referenced in Journal of Blood & Lymph

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