Word of caution: Rectal cancer without response to neoadjuvant treatment - Do not wait for surgery.
AJCC
Neoadjuvant chemoradiation
Outcomes
Radiation response
Rectal cancer
Journal
American journal of surgery
ISSN: 1879-1883
Titre abrégé: Am J Surg
Pays: United States
ID NLM: 0370473
Informations de publication
Date de publication:
10 2023
10 2023
Historique:
received:
08
07
2022
revised:
05
02
2023
accepted:
22
03
2023
medline:
4
9
2023
pubmed:
10
4
2023
entrez:
9
4
2023
Statut:
ppublish
Résumé
We hypothesized that prolonging the interval to surgery in non-responders to neoadjuvant chemoradiation therapy (nCRT) could lead to worse oncologic outcomes. Rectal adenocarcinoma patients with poor tumor response to nCRT (AJCC tumor regression grade 3) were selected. Oncologic outcomes were evaluated according to the time interval between completion of nCRT and surgery. Among 56 non-responders, 28 patients surgically treated ≥8 weeks after completion of nCRT had worse disease-free survival (31% vs. 49%, p = 0.05) and worse overall survival (34% vs. 53%, p = 0.02) compared to patients <8 weeks. Using the three different intervals (≥12 weeks, 6-12 weeks, and< 6 weeks), waiting longer was consistently associated with worse overall (23% vs. 48% vs. 63%, p = 0.02) and worse cancer-specific survival (35% vs. 61% vs. 71%, p = 0.04), respectively. For rectal cancer patients who are non-responders to nCRT, delay of surgery may lead to worse oncologic outcomes.
Sections du résumé
BACKGROUND
We hypothesized that prolonging the interval to surgery in non-responders to neoadjuvant chemoradiation therapy (nCRT) could lead to worse oncologic outcomes.
METHODS
Rectal adenocarcinoma patients with poor tumor response to nCRT (AJCC tumor regression grade 3) were selected. Oncologic outcomes were evaluated according to the time interval between completion of nCRT and surgery.
RESULTS
Among 56 non-responders, 28 patients surgically treated ≥8 weeks after completion of nCRT had worse disease-free survival (31% vs. 49%, p = 0.05) and worse overall survival (34% vs. 53%, p = 0.02) compared to patients <8 weeks. Using the three different intervals (≥12 weeks, 6-12 weeks, and< 6 weeks), waiting longer was consistently associated with worse overall (23% vs. 48% vs. 63%, p = 0.02) and worse cancer-specific survival (35% vs. 61% vs. 71%, p = 0.04), respectively.
CONCLUSION
For rectal cancer patients who are non-responders to nCRT, delay of surgery may lead to worse oncologic outcomes.
Identifiants
pubmed: 37032235
pii: S0002-9610(23)00124-1
doi: 10.1016/j.amjsurg.2023.03.021
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
548-552Informations de copyright
Copyright © 2023 Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest Leonardo C Duraes, Matthew F Kalady, David Liska, Emre Gorgun, Hermann Kessler , Ana Otero Pineiro, Scott R Steele, and Michael A Valente have no disclosures or conflicts of interest associated with this paper.