A prospective analysis of patient outcome following treatment of T3 rectal cancer with neo-adjuvant chemoradiotherapy and transanal excision
- 274 Downloads
Local excision is an alternative to anterior or abdomino-perineal resection in patients with early rectal cancer. In more advanced disease, neo-adjuvant therapy (CRXT) can result in significant disease regression such that local excision may be considered. The primary aim was to assess oncological outcome in patients with T3 rectal cancer treated with CRXT and local excision due to unsuitability for or aversion to anterior resection and stoma. The secondary aim was to examine oncological outcomes in patients treated in a similar way in the published literature.
Between July 2006 and July 2009, patients with rectal cancer staged T3, N0/N1, M0 who were deemed unfit for or who refused anterior resection were offered long-course CRXT. Patients were restaged 8 weeks following completion. If there was a good response (regression grade 2 or 3 clinically and radiologically), full thickness transanal excision was performed. All patients were followed regularly (monthly CT abdomen/pelvis and annual endoscopy) to assess for recurrence of disease. A literature search of PubMed was performed to identify all prospective data available of T3 rectal cancers managed with CRXT and local excision.
Ten patients were treated over 3 years. Six patients had complete pathological response, while four patients had a partial response. The resection margins following local excision were clear in all. There was no local recurrence (median follow-up 24 months, range 9–42 months).
Neo-adjuvant chemoradiotherapy and local excision is an option in patients unfit for or averse to major surgical resection if there is a good response to CRXT.
KeywordsNeo-adjuvant therapy Local excision T3 rectal cancer
Conflict of interest
The authors state that they have no conflict of interest.
- 2.Beddy D, Hyland JM, Winter DC, Lim C, White A, Moriarty M, Armstrong J, Fennelly D, Gibbons D, Sheahan K (2008) A simplified tumor regression grade correlates with survival in locally advanced rectal carcinoma treated with neoadjuvant chemoradiotherapy. Ann Surg Oncol 15:3471–3477PubMedCrossRefGoogle Scholar
- 4.Bujko K, Nowacki MP, Nasierowska-Guttmejer A, Kepka L, Winkler-Spytkowska B, Suwinski R, Oledzki J, Stryczynska G, Wieczorek A, Serkies K, Rogowska D, Tokar P (2005) Prediction of mesorectal nodal metastases after chemoradiation for rectal cancer: results of a randomised trial: implication for subsequent local excision. Radiother Oncol 76:234–240PubMedCrossRefGoogle Scholar
- 5.Guillem JG, az-Gonzalez JA, Minsky BD, Valentini V, Jeong SY, Rodriguez-Bigas MA, Coco C, Leon R, Hernandez-Lizoain JL, Aristu JJ, Riedel ER, Nitti D, Wong WD, Pucciarelli S (2008) cT3N0 rectal cancer: potential overtreatment with preoperative chemoradiotherapy is warranted. J Clin Oncol 26:368–373PubMedCrossRefGoogle Scholar
- 6.Guillem JG, Chessin DB, Cohen AM, Shia J, Mazumdar M, Enker W, Paty PB, Weiser MR, Klimstra D, Saltz L, Minsky BD, Wong WD (2005) Long-term oncologic outcome following preoperative combined modality therapy and total mesorectal excision of locally advanced rectal cancer. Ann Surg 241:829–836PubMedCrossRefGoogle Scholar
- 8.Habr-Gama A, Perez RO, Proscurshim I, Rawet V, Pereira DD, Sousa AH, Kiss D, Cecconello I (2008) Absence of lymph nodes in the resected specimen after radical surgery for distal rectal cancer and neoadjuvant chemoradiation therapy: what does it mean? Dis Colon Rectum 51:277–283PubMedCrossRefGoogle Scholar
- 16.Smith FM, Coffey JC, Khasri NM, Walsh MF, Parfrey N, Gaffney E, Stephens R, Kennedy MJ, Kirwan W, Redmond HP (2005) Sentinel nodes are identifiable in formalin-fixed specimens after surgeon-performed ex vivo sentinel lymph node mapping in colorectal cancer. Ann Surg Oncol 12:504–509PubMedCrossRefGoogle Scholar