Skip to main content

Advertisement

SpringerLink
Log in

Further evidence for preoperative chemoradiotherapy and transanal endoscopic surgery (TEM) in T2-3s,N0,M0 rectal cancer

  • Research Article
  • Published:
Clinical and Translational Oncology Aims and scope Submit manuscript

Abstract

Purpose

Preoperative chemoradiotherapy and local excision via transanal endoscopic surgery (TEM) in T2–3s,N0,M0 rectal cancer achieve promising results in selected patients. We describe our long-term follow-up experience with this combination, and evaluate complete clinical and pathological responses, local recurrence and overall survival.

Methods

The prospective observational follow-up study carried out since 2007. Out of 476 consecutive patients treated with TEM, we selected those with adenocarcinoma of low or moderate grade of differentiation, clinical stages T2-superficial T3,N0,M0, who refused radical surgery. Preoperative chemoradiotherapy comprised 5-fluorouracil or capecitabine combined with radiotherapy at a dose of 50.4 Gy. TEM was performed after 8 weeks. Complications were recorded and long-term follow-up was conducted.

Results

Fifteen patients undergoing preoperative chemoradiotherapy and TEM (median age 76 years, 95 % CI 70.3–80.4, and median follow-up 38 months, 95 % CI 20–44) were studied. No local recurrence was observed, and only one patient (6.7 %) presented systemic relapse. The overall survival was 76 %. Complete clinical response was achieved in seven patients (46.7 %) and complete pathological response in four (26.7 %). With regard to toxicity associated with neoadjuvant treatment, four patients (26.7 %) developed grade 3 adverse effects; no grade 4 or 5 adverse effects were observed. There was no postoperative mortality.

Conclusions

The results of our study, with a response rate of 26.7 % and without local relapse, support the treatment of T2–3s,N0,M0 of rectal cancer with preoperative chemoradiotherapy and local excision (TEM).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. National Comprehensive Cancer Network. Rectal Cancer. Clinical Practice Guidelines in Oncology: National Comprehensive. Cancer Network; version 4, 2013; http://www.nccn.org. Accessed 15 August, 2013.

  2. Mellgren A, Sirivongs P, Rothenberger DA, Madoff RD, Garcia-Aguilar J. Is local excision adequate therapy for early rectal cancer? Dis Colon Rectum. 2000;43:1064–74.

    Article  CAS  PubMed  Google Scholar 

  3. Law WL, Chu KW. Anterior resection for rectal cancer with mesorectal excision: a prospective evaluation of 622 patients. Ann Surg. 2004;240:260–8.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Serra Aracil X, Bombardo Junca J, Mora Lopez L, Alcantara Moral M, Ayguavives Garnica I, Darnell Marti A, et al. Site of local surgery in adenocarcinoma of the rectum T2N0M0. Cir Esp. 2009;85(2):103–9.

    Article  PubMed  Google Scholar 

  5. Habr-Gama A, Perez RO, Nadalin W, Sabbaga J, Ribeiro U Jr, Silva e Sousa AH Jr, et al. Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results. Ann Surg. 2004;240:711–7.

    PubMed  PubMed Central  Google Scholar 

  6. Lezoche E, Guerrieri M, Paganini AM, Baldarelli M, De Sanctis A, Lezoche G. Long-term results in patients with T2–3 N0 distal rectal cancer undergoing radiotherapy before transanal endoscopic microsurgery. Br J Surg. 2005;92:1546–52.

    Article  CAS  PubMed  Google Scholar 

  7. Borschitz T, Wachtlin D, Möhler M, Schmidberger H, Junginger T. Neoadjuvant chemoradiation and local excision for T2-3 rectal cancer. Ann Surg Oncol. 2008;15(3):712–20.

    Article  PubMed  Google Scholar 

  8. Jorge JMN, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum. 1993;36:77–97.

    Article  CAS  PubMed  Google Scholar 

  9. Serra-Aracil X, Mora-Lopez L, Alcantara-Moral M, Caro-Tarrago A, Gomez-Diaz CJ, Navarro-Soto S. Transanal endoscopic surgery in rectal cancer. World J Gastroenterol. 2014;20:11538–45.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Merkel S, Mansmann U, Siassi M, Papadopoulos T, Hohenberger W, Hermanek P. The prognostic inhomogeneity in pT3 rectal carcinomas. Int J Colorectal Dis. 2001;16:298–304.

    Article  CAS  PubMed  Google Scholar 

  11. Brown G, Richards CJ, Bourne MW, Newcombe RG, Radcliffe AG, Dallimore NS, et al. Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison. Radiology. 2003;227(2):371–7.

    Article  PubMed  Google Scholar 

  12. Mohiuddin M, Regine WF, John WJ, Hagihara PF, McGrath PC, Kenady DE, et al. Preoperative chemoradiation in fixed distal rectal cancer: dose time factors for pathological complete response. Int J Radiat Oncol Biol Phys. 2000;46:883–8.

    Article  CAS  PubMed  Google Scholar 

  13. Mohiuddin M, Regine WF, Marks GJ, Marks JW. High dose preoperative radiation and the challenge of sphincter-preservation surgery for cancer of the distal 2 cm of the rectum. Int J Radiat Oncol Biol Phys. 1998;40:569–74.

    Article  CAS  PubMed  Google Scholar 

  14. Ahmad NR, Marks G, Mohiuddin M. High dose preoperative radiation for cancer of the rectum: impact of radiation dose on patterns of failure and survival. Int J Radiat Oncol Biol Phys. 1993;27:773–8.

    Article  CAS  PubMed  Google Scholar 

  15. Common Terminology Criteria for Adverse Events (CTCAE). Version 4.0. Published: May 28, 2009 (v4.03: June 14, 2010). http://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm. Accessed 15 Aug, 2013.

  16. Lezoche E, Baldarelli M, Lezoche G, Paganini AM, Gesuita R, Guerrieri M. Randomized clinical trial of endoluminal locoregional resection versus laparoscopic total mesorectal excision for T2 rectal cancer after neoadjuvant therapy. Br J Surg. 2012;99(9):1211–8.

    Article  CAS  PubMed  Google Scholar 

  17. Büess G, Hutterer F, Theis J. Das System für die Transanale Endoskopische Rektumoperation. Chirurg. 1984;55:677–80.

    PubMed  Google Scholar 

  18. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Bouzourene H, Bosman FT, Seelentag W, Matter M, Coucke P. Importance of tumor regression assessment in predicting the outcome in patients with locally advanced rectal carcinoma who are treated with preoperative radiotherapy. Cancer. 2002;94(4):1121–30.

    Article  PubMed  Google Scholar 

  20. Borschitz T, Heintz A, Junginger T. Transanal endoscopic microsurgical excision of pT2 rectal cancer: results and possible indications. Dis Colon Rectum. 2007;50:292–301.

    Article  PubMed  Google Scholar 

  21. Serra-Aracil X, Mora-Lopez L, Alcantara-Moral M, Corredera-Cantarin C, Gomez-Diaz C, Navarro-Soto S. Atypical indications for transanal endoscopic microsurgery to avoid major surgery. Tech Coloproctol. 2014;18(2):157–64.

    Article  CAS  PubMed  Google Scholar 

  22. Lambregts DM, Maas M, Bakers FC, Cappendijk VC, Lammering G, Beets GL, et al. Long-term follow-up features on rectal MRI during a wait-and-see approach after a clinical complete response in patients with rectal cancer treated with chemoradiotherapy. Dis Colon Rectum. 2011;54(12):1521–8.

    Article  PubMed  Google Scholar 

  23. Hiotis SP, Weber SM, Cohen AM, Minsky BD, Paty PB, Guillem JG, et al. Assessing the predictive value of clinical complete response to neoadjuvant therapy for rectal cancer: an analysis of 488 patients. J Am Coll Surg. 2002;194:131–5.

    Article  PubMed  Google Scholar 

  24. Garcia-Aguilar J. Transanal endoscopic microsurgery following neoadjuvant chemoradiation therapy in rectal cancer: a word of caution about patient selection? Dis Colon Rectum. 2013;56(1):1–3.

    Article  PubMed  Google Scholar 

  25. Perez RO, Habr-Gama A, Lynn PB, São Julião GP, Bianchi R, Proscurshim I, et al. Transanal endoscopic microsurgery for residual rectal cancer (ypT0-2) following neoadjuvant chemoradiation therapy: another word of caution. Dis Colon Rectum. 2013;56(1):6–13.

    Article  PubMed  Google Scholar 

  26. Callender GG, Das P, Rodriguez-Bigas MA, Skibber JM, Crane CH, Krishnan S, et al. Local excision after preoperative chemoradiation results in an equivalent outcome to total mesorectal excision in selected patients with T3 rectal cancer. Ann Surg Oncol. 2010;17(2):441–7.

    Article  PubMed  Google Scholar 

  27. Garcia-Aguilar J, Shi Q, Thomas CR Jr, Chan E, Cataldo P, Marcet J, et al. A phase II trial of neoadjuvant chemoradiation and local excision for T2N0 rectal cancer: preliminary results of the ACOSOG Z6041 trial. Ann Surg Oncol. 2012;19(2):384–91.

    Article  PubMed  Google Scholar 

  28. Guerrieri M, Baldarelli M, Rimini M, Gesuita R, Lezoche G, Romiti C, et al. Transanal endoscopic microsurgery for rectal tumors: an option to radical surgery? Minerva Chir. 2013;68(3):289–98.

    CAS  PubMed  Google Scholar 

  29. Yu CS, Yun HR, Shin EJ, Lee KY, Kim NK, Lim SB, et al. Colorectal Cancer Study Group, Korean Society of Coloproctology. Local excision after neoadjuvant chemoradiation therapy in advanced rectal cancer: a national multicenter analysis. Am J Surg. 2013;206:482–7.

    Article  PubMed  Google Scholar 

  30. Sauer R, Liersch T, Merkel S, Fietkau R, Hohenberger W, Hess C, et al. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol. 2012;30(16):1926–33.

    Article  CAS  PubMed  Google Scholar 

  31. Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351(17):1731–40.

    Article  CAS  PubMed  Google Scholar 

  32. O’Connell MJ, Colangelo LH, Beart RW, Petrelli NJ, Allegra CJ, Sharif S, et al. Capecitabine and oxaliplatin in the preoperative multimodality treatment of rectal cancer: surgical end points from National Surgical Adjuvant Breast and Bowel Project trial R-04. J Clin Oncol. 2014;32(18):1927–34.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

We thank all the members of the multidisciplinary colorectal committee at Parc Tauli University Hospital: Eva Ballesteros, Antonio Malet (Radiodiagnostic Service), Rafael Campo, Enric Brullet, Felix Junquera, Valentí Puig, Eva Martínez (Digestive Pathology Service); the coordinator of the committee, Maite Martinez.

Author information

Authors and Affiliations

  1. Medical Oncology Service, Parc Tauli University Hospital, Universidad Autonoma de Barcelona, Parc Tauli, no. 1, 08208, Sabadell, Barcelona, Spain

    C. Pericay, J. Ocaña-Rojas, E. Dotor, A. Pisa & E. Saigí

  2. Coloproctology Unit, General and Digestive Surgery Service, Parc Tauli University Hospital, Universidad Autonoma de Barcelona, Sabadell, Barcelona, Spain

    X. Serra-Aracil & L. Mora-López

  3. Pathology Service, Parc Tauli University Hospital, Universidad Autonoma de Barcelona, Sabadell, Barcelona, Spain

    A. Casalots

Authors
  1. C. Pericay
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. X. Serra-Aracil
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Ocaña-Rojas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L. Mora-López
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E. Dotor
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. Casalots
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A. Pisa
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. E. Saigí
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Pericay.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pericay, C., Serra-Aracil, X., Ocaña-Rojas, J. et al. Further evidence for preoperative chemoradiotherapy and transanal endoscopic surgery (TEM) in T2-3s,N0,M0 rectal cancer. Clin Transl Oncol 18, 666–671 (2016). https://doi.org/10.1007/s12094-015-1415-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12094-015-1415-7

Keywords

Search

Navigation