دورية أكاديمية
Nonoperative management of rectal cancer after chemoradiation opposed to resection after complete clinical response. A comparative study.
| العنوان: | Nonoperative management of rectal cancer after chemoradiation opposed to resection after complete clinical response. A comparative study. |
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| المؤلفون: | Araujo RO; Department of Abdominal and Pelvic Surgery, National Institute of Cancer - INCA, Rio de Janeiro, Brazil. Electronic address: raraujooncologia@gmail.com., Valadão M; Department of Abdominal and Pelvic Surgery, National Institute of Cancer - INCA, Rio de Janeiro, Brazil., Borges D; Department of Abdominal and Pelvic Surgery, National Institute of Cancer - INCA, Rio de Janeiro, Brazil., Linhares E; Department of Abdominal and Pelvic Surgery, National Institute of Cancer - INCA, Rio de Janeiro, Brazil., de Jesus JP; Department of Abdominal and Pelvic Surgery, National Institute of Cancer - INCA, Rio de Janeiro, Brazil., Ferreira CG; Clinical Oncology and Applied Research Centre, National Institute of Cancer - INCA, Rio de Janeiro, Brazil., Victorino AP; Clinical Oncology and Applied Research Centre, National Institute of Cancer - INCA, Rio de Janeiro, Brazil., Vieira FM; Clínicas Oncológicas Integradas - COI, Rio de Janeiro, Brazil., Albagli R; Department of Abdominal and Pelvic Surgery, National Institute of Cancer - INCA, Rio de Janeiro, Brazil. |
| المصدر: | European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology [Eur J Surg Oncol] 2015 Nov; Vol. 41 (11), pp. 1456-63. Date of Electronic Publication: 2015 Aug 29. |
| نوع المنشور: | Comparative Study; Journal Article; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Country of Publication: England NLM ID: 8504356 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-2157 (Electronic) Linking ISSN: 07487983 NLM ISO Abbreviation: Eur J Surg Oncol Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: Original Publication: London ; New York : Academic Press, [1985- |
| مواضيع طبية MeSH: | Adenocarcinoma/*therapy , Antineoplastic Agents/*therapeutic use , Colectomy/*methods , Rectal Neoplasms/*therapy, Chemoradiotherapy/methods ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Neoadjuvant Therapy ; Retrospective Studies ; Time Factors ; Treatment Outcome |
| مستخلص: | Introduction: Surgery is the standard treatment of rectal cancer after neoadjuvant therapy. Some authors advocate a nonoperative management (NOM) after complete clinical response (cCR) following chemoradiotherapy (CRT). We compare our results with NOM to standard resection in a retrospective analysis. Methods: Rectal adenocarcinomas submitted to NOM after CRT between September 2002 and December 2013 were compared to surgical patients that had pathological complete response (pCR) during the same period. Endpoints were Overall Survival (OS), Disease Free Survival (DFS), Local Relapse (LR) and Distant Relapse (DR). Results: Forty-two NOM patients compared to 69 pCR patients operated after a median interval of 35 weeks after CRT. NOM tumors were distal (83.3% vs 59.4%, p = 0.011), less obstructive (26.2% vs 54.4%, p = 0.005) and had a lower digital rectal score (p = 0.024). Twelve (28.0%) recurrences in NOM group and eight (11.5%) in the surgical group occurred after a follow-up of 47.7 and 46.7 months respectively. Isolated LR occurred in five (11%) NOM patients and one (1.4%) in the surgical group. Four (80%) LR were surgically salvaged in NOM group. No difference in OS was found (71.6% vs 89.9%, p = 0.316) but there was a higher DFS favoring surgical group (60.9% vs 82.8%, p = 0.011). Distal tumors had worse OS compared to proximal tumors in surgical group (5-year OS of 85.5% vs 96.2%, p = 0.038). Conclusion: The NOM achieved OS comparable to surgical treatment and spared patients from surgical morbidity but it resulted in more recurrences. This approach cannot be advocated routinely and controlled trials are warranted. (Copyright © 2015 Elsevier Ltd. All rights reserved.) |
| فهرسة مساهمة: | Keywords: Complete clinical response; Neoadjuvant therapy; Nonoperative treatment; Rectal cancer; Rectal resection |
| المشرفين على المادة: | 0 (Antineoplastic Agents) |
| تواريخ الأحداث: | Date Created: 20150913 Date Completed: 20160119 Latest Revision: 20151013 |
| رمز التحديث: | 20231215 |
| DOI: | 10.1016/j.ejso.2015.08.156 |
| PMID: | 26362228 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 1532-2157 |
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| DOI: | 10.1016/j.ejso.2015.08.156 |