Abstract
BackgroundPreoperative chemoradiotherapy is usually not indicated for cT2N0 rectal cancer. Abdominoperineal resection is the standard treatment for distal rectal tumors. The aim of the study was to evaluate the actual sphincter-preservation rate in patients with distal cT2N0 rectal cancer given neoadjuvant chemoradiotherapy.MethodsData were retrospectively collected for all patients who were diagnosed with distal cT2N0 rectal cancer at a tertiary medical center in 2000–2008 and received chemoradiotherapy followed by surgery (5–7 weeks later).ResultsThirty-three patients (22 male) of median age 65 years (range, 32–88) were identified. Tumor distance from the anal verge ranged from 0 to 5 cm. R0 resection with sphincter preservation was accomplished in 22 patients (66%), with a 22% pathological complete response rate. Median follow-up time was 62 months (range 7–120). There were no local failures. Crude disease-free and overall survival were 82% and 86%, respectively. Factors associated with sphincter preservation were tumor location (OR = 0.58, p = 0.02, 95% CI = 0.37-0.91) and pathological downstaging (OR = 7.8, p = 0.02, 95% CI = 1.35-45.85). Chemoradiotherapy was well tolerated.ConclusionHigh rates of sphincter preservation can be achieved after preoperative chemoradiotherapy for distal cT2N0 rectal cancer, with tolerable toxicity, without compromising oncological outcome.
Highlights
Preoperative chemoradiotherapy is usually not indicated for cT2N0 rectal cancer
Among the 324 patients identified, we selected those with distal cT2N0 disease who were being clinically considered by their surgeons for an abdominoperineal resection (APR) and were referred for preoperative CRT to increase the probability of a sphincter-preserving procedure
The tumor was downstaged after CRT in 14 patients (42%), of whom 7 (22% of the entire group) had pT1 and 7 (22% of the entire group) had a pathological complete response
Summary
Preoperative chemoradiotherapy is usually not indicated for cT2N0 rectal cancer. Abdominoperineal resection is the standard treatment for distal rectal tumors. The aim of the study was to evaluate the actual sphincter-preservation rate in patients with distal cT2N0 rectal cancer given neoadjuvant chemoradiotherapy. The main aims of rectal cancer treatment are locoregional control and improvement of overall and diseasefree survival. The standard treatment for rectal cancer consists of radical surgery with total or partial tumor-specific mesorectal excision. Short-course radiotherapy or long- course chemoradiotherapy (CRT) may be administered preoperatively, depending on the location of the tumor in the rectum and the disease stage [1]. For patients with very low-lying rectal tumors, abdominoperineal resection (APR) is the traditional method of choice [2]. The use of sphincter-sparing procedures has been increasing [3] owing to advances in surgical technique and instruments, the introduction of specialized high-volume centers, and an improved understanding of the sphincter mechanism and the tumor biology [1].
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