Identification of locally advanced rectal cancer with low risk of local recurrence.

Qiao-Xuan Wang,Zhi-Zhong Pan,Pei-Rong Ding,Xu Zhang,Pei-Qiang Cai,Xin An,Lan Xie,Shao-Hua Li

doi:10.1371/journal.pone.0117141

Qiao-Xuan Wang, Zhi-Zhong Pan + Show 6 more

Open Access

https://doi.org/10.1371/journal.pone.0117141

Copy DOI

Abstract

BackgroundThe routine application of neoadjuvant chemoradiotherapy for T3N0 rectal cancer remains controversial. The aim of this study was to use clinical, Magnetic resonance imaging, and pathological parameters to identify a subgroup of patients with low risk of local recurrence who might be precluded from neoadjuvant chemoradiotherapy.MethodsWe retrospectively reviewed a prospectively maintained database of consecutive rectal cancer patients who underwent curative resection. 166 pathologic confirmed T3N0 rectal cancer patients with tumor located 5–12cm above the anal verge and preoperative circumferential resection margin>1mm were included in analysis. The primary outcomes measured were3- and 5-year local recurrence rates.ResultsLocal recurrence was demonstrated during follow-up in 5 patients; the actuarial overall 3- and 5-year local recurrence rates were 2.5% and 3.4%, respectively. Inadequate sampling of lymph nodes (≤12) was associated with higher local recurrence (P = 0.03) in this group of patients.ConclusionFor upper and middle T3N0 rectal cancer with preoperative circumferential resection margin>1mm, local recurrence rate after total mesorectal excision is low and surgery alone may be enough for this group of patients.

Highlights

The current standard therapy for locally advanced rectal cancer is neoadjuvant chemoradiotherapy (CRT) followed by total mesorectal excision (TME) [1]
For upper and middle T3N0 rectal cancer with preoperative circumferential resection margin>1mm, local recurrence rate after total mesorectal excision is low and surgery alone may be enough for this group of patients
Risk of local recurrence is significantly associated with several other factors like location of tumor [6] and circumferential resection margin (CRM) status [7, 8], which should be taken into account when determine the necessity of neoadjuvant CRT

Summary

Introduction

The current standard therapy for locally advanced rectal cancer is neoadjuvant chemoradiotherapy (CRT) followed by total mesorectal excision (TME) [1]. Several studies have reported that local recurrence can be well controlled at a relatively low level (4–8%) by surgery alone in patients with T3N0 rectal cancer, suggesting that neoadjuvant CRT might not be necessary for these patients [2,3,4,5]. The European Society for Medical Oncology (ESMO) guideline for treatment of rectal cancer recommends a flexible strategy on application of neoadjuvant therapy basing on clinical staging, location of tumor, and risk of CRM involvement [9], the evidence is still limited. The aim of this study was to use clinical, Magnetic resonance imaging, and pathological parameters to identify a subgroup of patients with low risk of local recurrence who might be precluded from neoadjuvant chemoradiotherapy

Objectives

Methods

Results

Conclusion