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Outcome Standards for an Organ Preservation Strategy in Stage II and III Rectal Adenocarcinoma after Neoadjuvant Chemoradiation

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Neoadjuvant chemoradiotherapy is the standard of care for patients with locally advanced mid and distal rectal cancer. Tumor regression is variable, and this study was designed to evaluate the pathological response and impact on long-term disease control in responders and nonresponders.

Methods

A total of 303 consecutive patients with cStage II and III mid and distal rectal adenocarcinoma were identified. The mean age was 64 years and 63% were men. Patients received neoadjuvant chemoradiotherapy (45 Gy) with a continuous infusion of 5-fluorouracil. Total mesorectal excision (TME) was performed after an interval of 6–8 weeks. Tumors were stratified as responders (ypT0 or ypT1) and nonresponders (≥ypT3). All ypT2 were separately categorized.

Results

Tumors of 84 patients were classified as responders (27.5%) versus nonresponders in 144 patients (47.5%). Pathological tumor stage was ypT2 in 75 patients (25%). After a median follow-up of 55 months, the 5-year cancer-specific survival rate was 98% and the disease-free survival rate was 91% in responders versus 82% (P < 0.0025) and 60% (P < 0.0001), respectively, for the nonresponders.

Conclusions

After neoadjuvant chemoradiotherapy and TME surgery for locally advanced rectal cancer and complete or near-complete pathological tumor response oncological outcome is very good. These results set the standards for a rectum-sparing strategy.

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Acknowledgment

We thank Steffen Fieuws from the Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat) for statistical assistance.

Conflict of Interest Statement

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven, Belgium

    Albert M. Wolthuis MD, Freddy Penninckx MD, PhD & André D’Hoore MD, PhD

  2. Department of Radiation Oncology, University Hospital Gasthuisberg, Leuven, Belgium

    Karin Haustermans MD, PhD

  3. Department of Pathology, University Hospital Gasthuisberg, Leuven, Belgium

    Nadine Ectors MD, PhD

  4. Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium

    Eric Van Cutsem MD, PhD

Authors
  1. Albert M. Wolthuis MD
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  2. Freddy Penninckx MD, PhD
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  6. André D’Hoore MD, PhD
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Correspondence to Albert M. Wolthuis MD.

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Wolthuis, A.M., Penninckx, F., Haustermans, K. et al. Outcome Standards for an Organ Preservation Strategy in Stage II and III Rectal Adenocarcinoma after Neoadjuvant Chemoradiation. Ann Surg Oncol 18, 684–690 (2011). https://doi.org/10.1245/s10434-010-1324-5

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  • DOI: https://doi.org/10.1245/s10434-010-1324-5

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