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Patterns of Local Recurrence and Oncologic Outcomes in T3 Low Rectal Cancer (≤5 cm from the Anal Verge) Treated With Short-Course Radiotherapy With Delayed Surgery

Outcomes in T3 Low Rectal Cancer Treated With Short-Course Radiotherapy With Delayed Surgery

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

ABSTRACT

Background

Short-course radiotherapy with delayed surgery (SRT-delay) is still under clinical investigation for its efficacy in treating low rectal cancer (≤5 cm from the anal verge). This study was designed to assess the pattern of local recurrence and oncologic outcomes in T3 low rectal cancer treated with SRT-delay.

Methods

This study enrolled T3 low rectal cancer patients without distant metastasis between 2003 and 2015. All patients received total mesorectal excision following SRT-delay (25 Gy/10 fractions/5 days + S-1 radiosensitizer with a 4-week delay of surgery). The median follow-up period was 69 (range 1–149) months.

Results

A total 119 consecutive patients had low rectal cancer; 104 (87.4 %) underwent intersphincteric resection (ISR), and 15 (12.6 %) underwent abdominoperineal resection (APR). Fifty-six patients (47.1 %) were ypT-downstaged, 86 (72.2 %) were ypN0, and 10 (8.4 %) had circumferential resection margin involvement. The 5-year local recurrence-free survival, recurrence-free survival, and overall survival were 93.0, 76.2, and 80.5 %, respectively. Nine patients experienced local recurrence: lateral pelvic recurrence in six patients (5.0 %) and central pelvic recurrence in three (2.5 %).

Conclusions

A total of 87.4 % of sphincter-preserving surgeries were performed for T3 low rectal cancer following SRT-delay. Pathological tumor downstaging, circumferential resection margin involvement, local recurrence, and oncologic outcomes were acceptable; therefore, the SRT-delay regimen may be an option for treating T3 low rectal cancer.

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Authors and Affiliations

  1. Department of Surgery, Meiwa Hospital, Nishinomiya, Hyogo, Japan

    Naohito Beppu MD, PhD, Fumihiko Kimura MD, PhD, Tsukasa Aihara MD, PhD, Hidenori Yanagi MD, PhD & Naoki Yamanaka MD, PhD

  2. Department of Radiology, Meiwa Hospital, Nishinomiya, Japan

    Hiroshi Doi MD, PhD

  3. Department of Surgrey, Hyogo College of Medicine, Nishinomiya, Japan

    Naohiro Tomita MD, PhD

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  1. Naohito Beppu MD, PhD
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  2. Fumihiko Kimura MD, PhD
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  3. Tsukasa Aihara MD, PhD
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  4. Hiroshi Doi MD, PhD
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  6. Hidenori Yanagi MD, PhD
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  7. Naoki Yamanaka MD, PhD
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Correspondence to Naohito Beppu MD, PhD.

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Beppu, N., Kimura, F., Aihara, T. et al. Patterns of Local Recurrence and Oncologic Outcomes in T3 Low Rectal Cancer (≤5 cm from the Anal Verge) Treated With Short-Course Radiotherapy With Delayed Surgery. Ann Surg Oncol 24, 219–226 (2017). https://doi.org/10.1245/s10434-016-5604-6

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