Is routine use of adjuvant chemotherapy for rectal cancer with complete pathological response justified?

Abstract Background Patients with locally advanced rectal cancer (LARC) receiving neoadjuvant chemoradiation (nCRT) can have a complete pathologic response (pCR), and are given postoperative adjuvant chemotherapy (ACT). Methods A prospectively maintained outcomes database was queried for patients wh...

Full description

Saved in:
Bibliographic Details
Published in:The American journal of surgery 2017-03, Vol.213 (3), p.478-483
Main Authors: Gamaleldin, Maysoon, Church, James M, Stocchi, Luca, Kalady, Mathew, Liska, David, Gorgun, Emre
Format: Article
Language:English
Subjects:
Adjuvant chemotherapy
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Cancer therapies
Chemoradiotherapy
Chemotherapy
Chemotherapy, Adjuvant
Complete pathological response
Demographics
Disease-Free Survival
Female
Fluorouracil - administration & dosage
Follow-Up Studies
Humans
Leucovorin - administration & dosage
Male
Medical records
Middle Aged
Neoadjuvant chemoradiation
Neoadjuvant Therapy
Neoplasm Metastasis
Neoplasm Recurrence, Local
NMR
Nuclear magnetic resonance
Ostomy
Pancreatic cancer
Pathology
Patients
Prospective Studies
Rectal cancer
Rectal Neoplasms - mortality
Rectal Neoplasms - therapy
Surgeons
Surgery
Systemic diseases
Tomography
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Abstract Background Patients with locally advanced rectal cancer (LARC) receiving neoadjuvant chemoradiation (nCRT) can have a complete pathologic response (pCR), and are given postoperative adjuvant chemotherapy (ACT). Methods A prospectively maintained outcomes database was queried for patients who had pCR to nCRT for LARC from 2000 to 2012. Local recurrence and survival were analyzed according to whether patients received ACT. Results We identified 139 patients and excluded 9 due to lack of follow-up. Mean age was 58.9 ± 11.8 years. 83 patients (63.8%) did not receive ACT (Group A) and 47 (36.2%) did (Group B). Mean follow-up was 5.7 ± 3 and 5.6 ± 3.5 years for Groups A and B respectively (p = 0.51). Groups were comparable in age, gender, tumor differentiation, and clinical staging. There were no differences in oncological outcomes. Conclusion Avoiding routine use of ACT in patients with a pCR may be considered. Further justification of this approach warrants prospective randomized studies. Summary A subset of patients with locally advanced rectal cancer receiving neoadjuvant chemoradiation develop a complete pathologic response after curative surgery, yet appear to not benefit from routine adjuvant chemotherapy.
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2016.11.028