Long-term results using local excision after preoperative chemoradiation among selected T3 rectal cancer patients

摘要: Abstract purpose To assess the pelvic failure among patients with T3 rectal cancer treated local excision after preoperative chemoradiation. Methods and materials Between January 1990 June 2002, 431 clinically staged were chemoradiation followed by surgical resection. Full-thickness [Kraske ( n = 3) or a transanal 23)] was performed in 26 because of patient refusal abdominoperineal resection (APR) 13), medical comorbidity 4), physician preference complete clinical response 6), other reasons 3). All continuous-infusion 5-fluorouracil (5-FU) (300 mg/m 2 Monday to Friday) concomitant radiation (45 Gy 25 fractions 3-field belly board technique). Ten local-excision received boost during last week therapy (1.5-Gy second daily fractions) for total dose 52.5 Gy. Similar treatment mesorectal 405 patients. Among patients, median tumor size 3.5 cm (range, 0.5–7 cm). Well-differentiated moderately-differentiated histology present all but 3 cases, endoscopic ultrasound staging examination Based on CT findings, 1 node positive. The circumference involved 33%, (20%–75%). distance from anal verge 1–8 Results mean follow-up 46 months 5–109 months) group. In group, 19 had only residual scarring noted digital rigid proctoscopy before surgery. Fourteen (54%) histologic chemoradiation, 9 (35%) microscopic disease, (12%) gross disease. Two intrapelvic recurrences occurred at 76 20 (6% 5-year actuarial recurrence rate). This rate compared an 8% 6% subgroup mesorectal-excision One additional recurred inguinal lymph subsequently died metastatic A cancer. Actuarial overall survival 5 years 86% group 81% p NS), 85% APR LAR NS). Conclusions experience stimulated APR, highly selected who responded well conventional external-beam radiotherapy (CXRT) undergo excision. Most these pathologic response. Local control rates are comparable those achieved strategy should be prospectively studied low have no evidence