Rectal cancer: delaying surgery after CRT a better choice

  • Akgun E & al.
  • Br J Surg
  • 29 Aug 2018

  • curated by Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • Patients with locally advanced rectal cancer who wait >8 weeks between chemoradiotherapy (CRT) and total mesorectal excision (TME) have higher rates of pathological complete response (pCR) and better disease regression than those who undergo surgery ≤8 weeks.

Why this matters

  • Previous studies on the association between wait times between CRT and resection yielded conflicting results.

Study design

  • Phase 3, randomized, parallel-group controlled trial.
  • 327 patients with locally advanced rectal cancer underwent surgery ≤8 weeks after CRT (classical interval [CI] group; n=160) or >8 weeks after CRT (long interval [LI] group; n=167).
  • Funding: None disclosed.

Key results

  • pCR rate higher in LI group (18.6% vs 10.0%; P=.027).
  • Best pCR rates were achieved in the LI group, at intervals of 10-11 weeks (71-77 days; 29% of patients) and 9-10 weeks (64-70 days; 22% of patients).
  • LI group had significantly greater disease regression, with better stage (P=.004) and T category (P=.001).
  • No significant difference between groups in R0 resection, TME quality, rates of grade 3 mesorectal-plane surgery, or mortality.
  • Morbidity rate was lower in LI group (19.8% vs 22.5%; P=.307).

Limitations

  • Single-center study.

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