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Local Excision of Distal Rectal Cancer: An Update of Cancer and Leukemia Group B 8984

  • Original Contribution
  • Published:
Diseases of the Colon & Rectum

Abstract

Purpose

The efficacy of local excision in the treatment of some early-stage distal rectal cancers is still being debated, because few high-quality, long-term prospective data on outcomes are available.

Methods

Fifty-nine patients with T1 lesions were treated with local excision alone, whereas 51 patients with T2 lesions received external beam irradiation (5,400 cGY) and 5-fluorouracil (500 mg/m2 intravenously Days 1–3, Days 29–31) after local excision. Kaplan-Meier curves were used to estimate the primary outcomes. The log-rank test and Cox’s proportional hazards model were used to compare subgroups relative to these outcomes.

Results

With a median follow-up of 7.1 (range, 2.1–11.4) years, ten-year rates of overall survival were 84 percent for patients with T1 and 66 percent for T2 rectal cancer. Disease-free survival was 75 percent for T1 and 64 percent for T2 disease. Local recurrence rates for patients with T1 and T2 lesions were 8 and 18 percent, respectively, and rates of distant metastases were 5 percent for T1 and 12 percent for T2 lesions. T stage was a statistically significant predictor of overall survival (P = 0.04) and approached statistical significance as a predictor of disease-free survival (P = 0.07).

Conclusions

Local excision alone for T1 rectal adenocarcinomas is associated with low recurrence and good survival rates that remain durable with long-term follow-up. T2 lesions treated via local excision and adjuvant therapy are associated with higher recurrence rates.

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Author information

Authors and Affiliations

  1. Department of Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, Massachusetts, 02115, USA

    Jacob A. Greenberg M.D. & Ronald Bleday M.D.

  2. H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA

    David Shibata M.D.

  3. CALGB Statistical Center, Duke University Medical Center, Durham, North Carolina, USA

    James E. Herndon II Ph.D.

  4. Geisinger Health System, Danville, Pennsylvania, USA

    Glenn D. Steele Jr M.D., Ph.D.

  5. Dana-Farber Cancer Institute, Boston, Massachusetts, USA

    Robert Mayer M.D.

Authors
  1. Jacob A. Greenberg M.D.
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  2. David Shibata M.D.
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  3. James E. Herndon II Ph.D.
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  4. Glenn D. Steele Jr M.D., Ph.D.
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  5. Robert Mayer M.D.
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  6. Ronald Bleday M.D.
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Additional information

Read at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, June 2 to 6, 2007.

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Greenberg, J.A., Shibata, D., Herndon, J.E. et al. Local Excision of Distal Rectal Cancer: An Update of Cancer and Leukemia Group B 8984. Dis Colon Rectum 51, 1185–1194 (2008). https://doi.org/10.1007/s10350-008-9231-6

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  • DOI: https://doi.org/10.1007/s10350-008-9231-6

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