Node+ rectal cancer: watchful waiting OK after nCRT complete response

  • Habr-Gama A & al.
  • Dis Colon Rectum
  • 11 Mar 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • In patients with nonmetastatic rectal cancer who achieved a complete clinical response (cCR) to neoadjuvant chemoradiation therapy (nCRT), 5-year surgery-free and distant metastasis-free survival (DMFS) were similar in node-positive and node-negative patients.

Why this matters

  • There is concern that node-positive patients may be at increased risk for local regrowth, more advanced disease at time of recurrence, and poorer DMFS.

Study design

  • Retrospective analysis of 335 patients who underwent nCRT.
  • Median follow-up, 55 months.
  • Funding: None.

Key results

  • No pretreatment factors were associated with risk for local recurrence after achieving cCR.
  • 117 patients were node-positive and 218 were node-negative at baseline.
  • 62 node-positive patients (53.0%) and 135 node-negative patients (61.9%) achieved cCR and were managed nonoperatively.
  • Node-positive vs node-negative:
    • 5-year cancer-specific survival (83.9% vs 84.5%; P=.99).
    • DMFS (77.5% vs 80.5%; P=.49).
    • Surgery-free survival (39.7% vs 46.8%; P=.20).
  • When the analysis was restricted to patients who achieved cCR and were managed with watchful waiting, the differences were still nonsignificant:
    • 5-year overall cancer-specific survival (90.3% vs 90.9%; P=.86).
    • Distant metastases-free survival (88.2% vs 88.6%; P=.92).
    • Surgery-free survival (76% vs 75.8%; P=.88).

Limitations

  • Retrospective analysis.
  • Small sample size.
  • Single institution.

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