Planned organ preservation for early T2-3 rectal adenocarcinoma: A French, multicentre study.

Autor: Gérard JP; Department of Radiation Oncology, Centre Antoine-LACASSAGNE Nice University, Nice, Sophia, France. Electronic address: jean-pierre.gerard@nice.unicancer.fr., Barbet N; Department of Radiation Oncology, Bayard Lyon, Lyon-Villeurbanne, France; Department of Radiation Oncology, Mâcon, France., Gal J; Department of Clinical Research-Statistics, Centre Antoine LACASSAGNE Nice University, Nice, Sophia, France., Dejean C; Department of Radiation Oncology, Centre Antoine-LACASSAGNE Nice University, Nice, Sophia, France., Evesque L; Department of Medical Oncology and Gastro-Intestinal Cancer, Centre Antoine LACASSAGNE Nice University, Nice, Sophia, France., Doyen J; Department of Radiation Oncology, Centre Antoine-LACASSAGNE Nice University, Nice, Sophia, France., Coquard R; Department of Radiation Oncology, Bayard Lyon, Lyon-Villeurbanne, France., Gugenheim J; Department of Surgery, CHU Nice, Nice University, Nice, Sophia, France., Benizri E; Department of Surgery, CHU Nice, Nice University, Nice, Sophia, France., Schiappa R; Department of Clinical Research-Statistics, Centre Antoine LACASSAGNE Nice University, Nice, Sophia, France., Baudin G; Department of Radiology Diagnosis, Centre Antoine LACASSAGNE, Nice University, Nice, Sophia, France., Benezery K; Department of Radiation Oncology, Centre Antoine-LACASSAGNE Nice University, Nice, Sophia, France., François E; Department of Medical Oncology and Gastro-Intestinal Cancer, Centre Antoine LACASSAGNE Nice University, Nice, Sophia, France.
Jazyk: angličtina
Zdroj: European journal of cancer (Oxford, England : 1990) [Eur J Cancer] 2019 Feb; Vol. 108, pp. 1-16. Date of Electronic Publication: 2018 Dec 20.
DOI: 10.1016/j.ejca.2018.11.022
Abstrakt: Background: Neoadjuvant chemoradiotherapy (nCRT) and watch-and-wait policy as reported by Habr-Gama are references for organ preservation in rectal cancer. To increase the clinical complete response (cCR) and reduce the local recurrence rates, we report a retrospective analysis of a prospective cohort of selected T2-3 tumours treated in three French institutions using contact X-ray brachytherapy (CXB) with nCRT.
Methods: Tumour selection was based on digital rectal examination (DRE), rigid rectoscopy, magnetic resonance imaging (MRI) and/or endorectal ultrasound. Adenocarcinoma T2-3 < 5 cm largest diameter, M0 were treated, all with organ preservation intent. CXB delivering 90 Gy/3 fractions/4 weeks was combined with CRT (capecitabine 50). Strict evaluation of tumour response using DRE and rectoscopy ± MRI was performed at regular interval with prolonged surveillance.
Findings: Between 2002 and 2016, 74 consecutive patients were treated (median age: 74 years. T2: 45 and T3: 29). A cCR or near-cCR (mainly rectal wall ulceration) was noted at week 14 in 71 patients (95%). A local excision was performed in 13 patients. Of three partial responses (PRs), one salvage anterior resection was performed. With a median follow-up of 3 years, local recurrence (mainly in the rectal wall) was seen in seven patients. The 3-year local recurrence rate was 10%, and the cancer-specific survival, 88%. Two patients underwent radical proctectomy for PR or local recurrence and 96% preserved their rectum. Grade III acute toxicity was recorded in five patients. Rectal bleeding was the main late toxicity (grade III in 12%). Bowel function was scored as good or excellent in 85% of patients.
Interpretation: Combining CXB and nCRT in selected early T2-T3 rectal cancers may safely provide a high rate of cCR, organ preservation, and good bowel function with a risk of local recurrence below 15%. Such an approach could be offered to operable patients as a planned option for organ preservation.
(Copyright © 2018 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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