Rectal cancer: CRT complete response obviates need for surgery

  • Int J Radiat Oncol Biol Phys

  • curated by Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • Patients with stage II-III rectal adenocarcinoma who achieved a complete clinical response (cCR) after chemoradiation (CRT) without surgery had similar OS and disease-specific survival (DSS) as patients who underwent CRT and surgery.  

Why this matters

  • Nonoperative management of rectal cancer is growing in practice, in part because of the high rate of postoperative complications, but long-term data on oncologic outcomes were lacking.

Study design

  • 1313 patients with stage II-III rectal adenocarcinoma from the VA Central Cancer Registry underwent concurrent chemoradiation (CRT) with (n=1000) or without (n=313) subsequent surgery.
  • Funding: None disclosed.

Key results

  • Median OS was significantly longer for the surgical group compared with CRT alone (89.3 vs 30.6 months; HR, 0.366; P<.001>
  • Median DSS was not reached in the surgery group and was significantly longer than in the CRT-alone group (HR, 0.311; P<.001>
  • 20.8% of CRT-alone patients achieved cCR.
  • Median OS for CRT patients who achieved cCR was 73.5 months and was not significantly different than median OS of patients who received CRT plus surgery (HR, 0.786; 95% CI, 0.576-1.072).
  • Median DSS was not reached for cCR patients and was not significantly different than the median DSS for the CRT plus surgery patients (HR, 1.572; 95% CI, 0.826-2.957).

Limitations

  • Retrospective study.

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