Organ Preservation in cT2N0 Rectal Cancer After Neoadjuvant Chemoradiation Therapy The Impact of Radiation Therapy Dose-escalation and Consolidation Chemotherapy
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Citações na Scopus
108
Tipo de produção
article
Data de publicação
2019
Editora
LIPPINCOTT WILLIAMS & WILKINS
Indexadores
Título da Revista
ISSN da Revista
Título do Volume
Autores
JULIAO, Guilherme Pagin Sao
VAILATI, Bruna Borba
AGUILAR, Patricia Bailao
FERNANDEZ, Laura Melina
Autor de Grupo de pesquisa
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Coordenadores
Organizadores
Citação
ANNALS OF SURGERY, v.269, n.1, p.102-107, 2019
Resumo
Objective: To demonstrate the difference in organ-preservation rates and avoidance of definitive surgery among cT2N0 rectal cancer patients undergoing 2 different chemoradiation (CRT) regimens. Background: Patients with cT2N0 rectal cancer are more likely to develop complete response to neoadjuvant CRT. Organ preservation has been considered an alternative treatment strategy for selected patients. Radiation dose-escalation and consolidation chemotherapy have been associated with increased rates of response and may improve chances of organ preservation among these patients. Methods: Patients with distal and nonmetastatic cT2N0 rectal cancer managed by neoadjuvant CRT were retrospectively reviewed. Patients undergoing standard CRT (50.4 Gy and 2 cycles of 5-FU-based chemotherapy) were compared with those undergoing extended CRT (54 Gy and 6 cycles of 5-FUbased chemotherapy). Patients were assessed for tumor response at 8 to 10 weeks. Patients with complete clinical response (cCR) underwent organ-preservation strategy (""Watch and Wait""). Patients were referred to salvage surgery in the event of local recurrence during follow-up. Results: Thirty-five patients underwent standard and 46 patients extended CRT. Patients undergoing extended CRT were more likely to undergo organ preservation and avoid definitive surgical resection at 5years (67% vs 30%; P = 0.001). After development of a cCR, surgery-free survival is similar between extended and standard CRT groups at 5 years (78% vs 56%; P = 0.12). Conclusions: Dose-escalation and consolidation chemotherapy leads to increased long-term organ-preservation rates among cT2N0 rectal cancer. After achievement of a cCR, the risk for local recurrence and need for salvage surgery is similar, irrespective of the CRT regimen.
Palavras-chave
chemoradiation, neoadjuvant, organ preservation, rectal cancer, watch and wait
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