Long‑term survival without surgery following a complete response to pre‑operative chemoradiotherapy for rectal cancer: A case series

Yeo,Seung‑Gu; Kim,Dae   Yong; Oh,Jae  Hwan

doi:10.3892/ol.2013.1596

Long‑term survival without surgery following a complete response to pre‑operative chemoradiotherapy for rectal cancer: A case series

Authors:
- Seung‑Gu Yeo
- Dae Yong Kim
- Jae Hwan Oh
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Affiliations: Department of Radiation Oncology, Soonchunhyang University College of Medicine, Cheonan, Chungnam 330-721, Republic of Korea, Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi 410‑769, Republic of Korea
Published online on: October 1, 2013 https://doi.org/10.3892/ol.2013.1596
Pages: 1573-1576

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Abstract

Pre‑operative chemoradiotherapy (CRT) for rectal cancer yields a complete tumor response in 10‑30% of patients. There is an argument for omitting surgery in these patients, but this remains highly controversial and the supporting evidence based on long‑term follow‑up is lacking. The present study analyzed the long‑term outcomes of five patients with cT3 or cT4 rectal cancer who showed a clinical complete response (ycCR) following pre‑operative CRT and underwent no surgery. The ycCR status was determined 7‑12 weeks after the completion of CRT using clinical, endoscopic and radiological studies, including magnetic resonance imaging and biopsy. The follow‑up period was 54‑101 months. Three patients had no tumor recurrence and were alive with no evidence of disease at 101, 100 and 93 months, respectively. One patient developed local recurrence at 59 months and another developed lung metastasis at 32 months. The two patients with tumor recurrence remained disease‑free 42 and 22 months after salvage pelvic and thoracic surgery, respectively. Despite being a small series, the long‑term survival outcomes of the present study indicate that a non‑operative approach may be feasible for a proportion of rectal cancer patients who reveal a ycCR following pre‑operative CRT.

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1	Yeo SG, Kim DY, Kim TH, Chang HJ, Oh JH, Park W, Choi DH, Nam H, Kim JS, Cho MJ, Kim JH, Park JH, Kang MK, Koom WS, Kim JS, Nam TK, Chie EK, Kim JS and Lee KJ: Pathologic complete response of primary tumor following preoperative chemoradiotherapy for locally advanced rectal cancer: long-term outcomes and prognostic significance of pathologic nodal status (KROG 09-01). Ann Surg. 252:998–1004. 2010. View Article : Google Scholar
2	Kosinski L, Habr-Gama A, Ludwig K and Perez R: Shifting concepts in rectal cancer management: a review of contemporary primary rectal cancer treatment strategies. CA Cancer J Clin. 62:173–202. 2012. View Article : Google Scholar : PubMed/NCBI
3	Habr-Gama A, Perez RO, Nadalin W, Sabbaga J, Ribeiro U Jr, Silva e Sousa AH Jr, Campos FG, Kiss DR and Gama-Rodrigues J: Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results. Ann Surg. 240:711–718. 2004.PubMed/NCBI
4	Maas M, Beets-Tan RG, Lambregts DM, Lammering G, Nelemans PJ, Engelen SM, van Dam RM, Jansen RL, Sosef M, Leijtens JW, Hulsewe KW, Buijsen J and Beets GL: Wait-and-see policy for clinical complete responders after chemoradiation for rectal cancer. J Clin Oncol. 29:4633–4640. 2011. View Article : Google Scholar : PubMed/NCBI
5	Glynne-Jones R and Hughes R: Critical appraisal of the ‘wait and see’ approach in rectal cancer for clinical complete responders after chemoradiation. Br J Surg. 99:897–909. 2012.
6	Habr-Gama A, Perez RO, São Julião GP, Proscurshim I and Gama-Rodrigues J: Nonoperative approaches to rectal cancer: a critical evaluation. Semin Radiat Oncol. 21:234–239. 2011. View Article : Google Scholar : PubMed/NCBI
7	Habr-Gama A, Perez RO, Proscurshim I, Campos FG, Nadalin W, Kiss D and Gama-Rodrigues J: Patterns of failure and survival for nonoperative treatment of stage c0 distal rectal cancer following neoadjuvant chemoradiation therapy. J Gastrointest Surg. 10:1319–1329. 2006. View Article : Google Scholar : PubMed/NCBI
8	Merkel S, Mansmann U, Hohenberger W and Hermanek P: Time to locoregional recurrence after curative resection of rectal carcinoma is prolonged after neoadjuvant treatment: a systematic review and meta-analysis. Colorectal Dis. 13:123–131. 2011. View Article : Google Scholar
9	Lambregts DM, Vandecaveye V, Barbaro B, Bakers FC, Lambrecht M, Maas M, Haustermans K, Valentini V, Beets GL and Beets-Tan RG: Diffusion-weighted MRI for selection of complete responders after chemoradiation for locally advanced rectal cancer: a multicenter study. Ann Surg Oncol. 18:2224–2231. 2011. View Article : Google Scholar : PubMed/NCBI
10	Garcia-Aguilar J, Shi Q, Thomas CR Jr, Chan E, Cataldo P, Marcet J, Medich D, Pigazzi A, Oommen S and Posner M; ACOSOG. Pathologic complete response (pCR) to neoadjuvant chemoradiation (CRT) of uT2uN0 rectal cancer (RC) treated by local excision (LE): Results of the ACOSOG Z6041 trial. J Clin Oncol. 28(Suppl; abstr 3510): 15s2010.
11	Habr-Gama A, Perez RO, Wynn G, Marks J, Kessler H and Gama-Rodrigues J: Complete clinical response after neoadjuvant chemoradiation therapy for distal rectal cancer: characterization of clinical and endoscopic findings for standardization. Dis Colon Rectum. 53:1692–1698. 2010. View Article : Google Scholar
12	Habr-Gama A, Perez RO, Proscurshim I, Nunes Dos Santos RM, Kiss D, Gama-Rodrigues J and Cecconello I: Interval between surgery and neoadjuvant chemoradiation therapy for distal rectal cancer: does delayed surgery have an impact on outcome? Int J Radiat Oncol Biol Phys. 71:1181–1188. 2008. View Article : Google Scholar : PubMed/NCBI
13	Yeo SG, Kim DY, Park JW, Oh JH, Kim SY, Chang HJ, Kim TH, Kim BC, Sohn DK and Kim MJ: Tumor volume reduction rate after preoperative chemoradiotherapy as a prognostic factor in locally advanced rectal cancer. Int J Radiat Oncol Biol Phys. 82:e193–e199. 2012.PubMed/NCBI
14	Yu SK, Brown G, Heald RJ, Chua S, Cook G, Barbachano Y, Chau I, Wotherspoon A and Tait DM: Deferral of rectal surgery following a continued response to preoperative chemoradiotherapy (Watch and Wait) study: A phase II multicenter study in the United Kingdom. J Clin Oncol. 29(suppl 4; abstr 489)2011.