Local excision after neoadjuvant chemoradiation for rectal cancer: Is it an acceptable treatment option?

Abstract

3646 Background: Neoadjuvant concurrent chemoradiation (CCRT) followed by radical surgery is standard in patients (pts) with locally advanced rectal cancer (LARC). Nevertheless, some pts undergo local excision (LE) only, for various reasons. The role of LE in this setting is currently unclear; the main concern regarding LE is the possible neglectance of involved regional lymph nodes (LNs). We therefore evaluated the correlation between pathologic T stage and LN involvement following CCRT and the outcome of pts with good histologic response, i.e. pathological complete response (pCR), undergoing LE. Methods: 340 eligible pts, who underwent neoadjuvant CCRT followed by surgery for LARC between 1/1997 and 12/2007, were included in the study. LARC was defined as T3-4Nx, TxN+ or distal (≤ 6 cm from the anus) T2N0. Radiotherapy was standard (50.4-54 Gy in fractions of 1.8 Gy) and chemotherapy consisted of several common fluoropyrimidine-based regimens. Results: The median age of the whole group was 67 years, 50% were males and 52% had distal tumors. 309 pts (91%) underwent radical surgery, 22 (6%) had LE only and 9 (3%) did not have surgery following CCRT. Of the 22 pts who had LE only, 15 had pT0, 3- microscopic residual disease (mRd), 3-pT1 and 1-pT2. With a median follow-up of 34 month, two pts died, one with mRd and one with T1. We compared the outcome of pT0 pts (n = 37) who underwent radical surgery (group I) with that of pT0 pts (n = 15) who had LE only (group II). With a median follow-up of 48 month, 4 pts in group I had a recurrence (3-local, 1-distant) and none in group II; one pt died in group I and none in group II. There was no significant difference in 5-year disease-free survival (88% vs. 100%), pelvic recurrence-free survival (92% vs. 100%) and overall survival (97% vs. 100%) between the groups. Conclusions: In this small cohort, pts who underwent LE following neoadjuvant CCRT had a relatively good outcome. In pts with pCR, radical surgery did not result in an improved outcome. Therefore, LE may be an acceptable option, at least for pts with mural pCR. No significant financial relationships to disclose.