Neoadjuvant Therapy and Surgery in Rectal Adenocarcinoma: Analysis of Patients with Complete Tumor Remission

Journal of Coloproctology - Tập 33 - Trang 222-227 - 2013
V.A. de Andrade1, R.F. Leal2, J.J. Fagundes2, C.S. Rodrigues Coy2, M. de Lourdes Setsuko Ayrizono2
1School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
2Service of Coloproctology, Departament of Surgery, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil

Tóm tắt

AbstractIntroduction: the standard treatment for locally advanced extra-peritoneal rectal adenocarcinoma, consists of neoadjuvant treatment with radiotherapy and chemotherapy followed by total mesorectal excision.Objective: evaluate, retrospectively, the patients submitted to neoadjuvant therapy and surgery that presents with total remission of the lesion in the anatomopathological examination.Methods: between 2000 and 2010, 212 patients underwent surgery at the Coloproctology Unit at DMAD at FCM–UNICAMP. They were grouped as: rectosigmoidectomy and colorectal anastomosis (n = 54), rectosigmoidectomy with coloanal anastomosis (n = 41), 114 abdominoperineal resection of the rectum (n = 114) and other (n = 3).Results: thirty (14.2%) patients (mean age 57.6 years; 60% males) showed complete remission of the rectal lesion. 4 (13.3%) had compromised lymph nodes and/or lymphatic invasionAt follow-up (mean 51.9 months), 4 (13.3%) presented with local recurrence (one patient) or distant metastases (two patients had liver metastasis, one had liver and lung, and one had bone metastasis). The mean survival was 86.7%.Conclusion: patients with a complete tumor response show ed an increased survival rate, however, the same patients without evidence of residual tumors could develop local recurrence or distant metastases on a later follow-up.

Tài liệu tham khảo

Castaldo, 2009, Improvement of survival with response to neoadjuvant radiation therapy for rectal cancer, Arch Surg, 144, 129, 10.1001/archsurg.2008.549 Instituto 2013 Nacional de Câncer (INCA). http://www2.inca. gov.br/wps/wcm/connect/tiposdecancer/site/home/colorretal/definicao. Habr-Gama, 2004, Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results, Ann Surg, 240, 711, 10.1097/01.sla.0000141194.27992.32 Habr-Gama, 2006, Assessment and management of the complete clinical response of rectal cancer to chemoradiotherapy, Colorectal Dis, 8, 21, 10.1111/j.1463-1318.2006.01066.x Altenburg, 2009, A pesquisa de sangue oculto nas fezes associada a um questionário de sinais e sintomas na prevenção do câncer colorretal, Rev bras Coloproct, 29, 57, 10.1590/S0101-98802009000100008 Bipat, 2004, Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging - a meta-analysis. Radiology, 232, 773 Habr-Gama, 2011, Nonoperative approaches to rectal cancer: A critical evaluation, Semin Radiat Oncol, 21, 234, 10.1016/j.semradonc.2011.02.010 Habr-Gama, 2010, Complete clinical response after neoadjuvant chemoradiation for distal rectal cancer, Surg Oncol Clin N Am, 19, 829, 10.1016/j.soc.2010.08.001 Maas, 2011, Wait-and-see policy for clinical complete responders after chemoradiation for rectal cancer, J Clin Oncol, 29, 4633, 10.1200/JCO.2011.37.7176 Smith, 2012, Nonoperative management of rectal cancer with complete clinical response after neoadjuvant therapy, Ann Surg, 256, 965, 10.1097/SLA.0b013e3182759f1c Wichmann, 2002, Effect of preoperative radiochemotherapy on lymph node retrieval after resection of rectal cancer, Arch Surg., 137, 206, 10.1001/archsurg.137.2.206 Medich, 2001, Preoperative chemoradiotherapy and radical surgery for locally advanced distal rectal adenocarcinoma: pathologic findings and clinical implications, Dis Colon Rectum., 44, 1123, 10.1007/BF02234632 Dulk, 2007, Considerations and restrictions for non- operative treatment of rectal cancer in selected patients, The Lancet Oncol, 8, 570, 10.1016/S1470-2045(07)70184-5 Hiotis, 2002, Assessing the predictive value of clinical complete response to neoadjuvant therapy for rectal cancer: An analysis of 488 patients, J Am Coll Surg, 194, 131, 10.1016/S1072-7515(01)01159-0 Moore, 2004, Rate of pathologic complete response with increased interval between preoperative combined modality therapy and rectal cancer resection, Dis Colon Rectum, 47, 279, 10.1007/s10350-003-0062-1 Habr-Gama, 2008, 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, 10.1016/j.ijrobp.2007.11.035 Nyasavajjala, 2009, Neoadjuvant chemo-radiotherapy and rectal cancer: can the UK watch and wait with Brazil?, Colorectal Dis, 12, 33, 10.1111/j.1463-1318.2009.02054.x Sloothaak, 2013, Optimal time interval between neoadjuvant chemoradiotherapy and surgery for rectal cancer, Br J Surg, 100, 933, 10.1002/bjs.9112 Pinho, 2007, Resposta completa à terapia neoadjuvante no câncer de reto: Apenas sorte ou um resultado previsível?, Rev bras Coloproct, 27, 474, 10.1590/S0101-98802007000400017 Perez, 2012, Accuracy of positron emission tomography/computed tomography and clinical assesment in the detection of complete rectal tumor regression after neoadjuvant chemoradiation, Cancer, 15, 3501, 10.1002/cncr.26644 Issa, 2012, Long-term outcome of local excision after complete pathological response to neoadjuvant chemoradiation therapy for rectal cancer, World J Surg, 36, 2481, 10.1007/s00268-012-1697-7 Belluco, 2011, Long-term outcome of patients with complete pathologic response after neoadjuvant chemoradiation for cT3 rectal cancer: implications for local excision surgical strategies, Ann Surg Oncol, 18, 3686, 10.1245/s10434-011-1822-0 Campos-Lobato, 2011, Pathologic complete response after neoadjuvant treatment for rectal cancer decreases distant recurrence and could eradicate local recurrence, Ann Surg Oncol, 18, 1590, 10.1245/s10434-010-1506-1 Maas, 2010, Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data, Lancet Oncol, 11, 835, 10.1016/S1470-2045(10)70172-8 Martin, 2012, Systematic review and meta-analysis of outcomes following pathological complete response to neoadjuvant chemoradiotherapy for rectal cancer, Br J Surg, 99, 918, 10.1002/bjs.8702 Zorcolo, 2012, Complete pathologic response after combined modality treatment for rectal cancer and long-term survival: a meta-analysis, Ann Surg Oncol, 19, 2822, 10.1245/s10434-011-2209-y Smith, 2012, The surgical significance of residual mucosal abnormalities in rectal cancer following neoadjuvant chemoradiotherapy, Br J Surg, 99, 993, 10.1002/bjs.8700 Tranchart, 2012, What is the incidence of metastatic lymph node involvement after significant pathologic response of primary tumor following neoadjuvant treatment for locally advanced rectal cancer, Ann Surg Oncol Habr-Gama, 2006, Patterns of failure and survival for nonoperative treatment of stage c0 distal rectal cancer following neoadjuvant chemoradiation therapy, J Gastrointest Surg, 10, 1319, 10.1016/j.gassur.2006.09.005 Stipa, 2004, Residual mesorectal lymph node involvement following neoadjuvant combined-modality therapy: Rationale for radical resection?, Ann Surg Oncol, 11, 187, 10.1245/ASO.2004.06.010