Chemoradiation therapy for rectal cancer in the distal rectum followed by organ-sparing transanal endoscopic microsurgery (CARTS study)

Autor: M Verseveld, E J R de Graaf, C Verhoef, E van Meerten, C J A Punt, I H J T de Hingh, I D Nagtegaal, J J M E Nuyttens, C A M Marijnen, J H W de Wilt, P J Tanis, G M J Bökkerink, H Rütten, P G Doornebosch, E J Derksen, R S Dwarkasing, A Cats, R A E M Tollenaar, H J T Rutten, J W A Leijtens, G P van der Schelling, A J ten Tije, G Lammering, G L Beets, T J Aufenacker, A Pronk, E R Manusama, C Hoff, A J A Bremers
Přispěvatelé: RS: NUTRIM - R2 - Gut-liver homeostasis, Surgery, CCA -Cancer Center Amsterdam, Oncology, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Medical Oncology, Radiotherapy
Rok vydání: 2015
Předmět:
Adult
Male
Natural Orifice Endoscopic Surgery
medicine.medical_specialty
Microsurgery
Colorectal cancer
SURGERY
medicine.medical_treatment
THICKNESS LOCAL EXCISION
MULTICENTER
Rectum
Anal Canal
Antineoplastic Agents
II CLINICAL-TRIAL
CHEMORADIOTHERAPY
Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14]
SDG 3 - Good Health and Well-being
DOSE PREOPERATIVE RADIATION
NEOADJUVANT CHEMORADIATION
Tumours of the digestive tract Radboud Institute for Molecular Life Sciences [Radboudumc 14]
medicine
Humans
RADICAL RESECTION
Neoadjuvant therapy
Aged
Retrospective Studies
Aged
80 and over
business.industry
Rectal Neoplasms
TOTAL MESORECTAL EXCISION
Chemoradiotherapy
Adjuvant
Middle Aged
medicine.disease
Minimal residual disease
Total mesorectal excision
Surgery
Radiation therapy
Radiography
medicine.anatomical_structure
Treatment Outcome
Female
business
Chemoradiotherapy
Follow-Up Studies
RADIOTHERAPY
Zdroj: British Journal of Surgery, 102(7), 853-860
British Journal of Surgery, 102(7), 853-860. Wiley
British journal of surgery, 102(7), 853-860. John Wiley and Sons Ltd
British Journal of Surgery, 102(7), 853-860. John Wiley & Sons Ltd.
British Journal of Surgery, 102, 7, pp. 853-60
British Journal of Surgery, 102, 853-60
ISSN: 0007-1323
DOI: 10.1002/bjs.9809
Popis: Background This prospective multicentre study was performed to quantify the number of patients with minimal residual disease (ypT0–1) after neoadjuvant chemoradiotherapy and transanal endoscopic microsurgery (TEM) for rectal cancer. Methods Patients with clinically staged T1–3 N0 distal rectal cancer were treated with long-course chemoradiotherapy. Clinical response was evaluated 6–8 weeks later and TEM performed. Total mesorectal excision was advocated in patients with residual disease (ypT2 or more). Results The clinical stage was cT1 N0 in ten patients, cT2 N0 in 29 and cT3 N0 in 16 patients. Chemoradiotherapy-related complications of at least grade 3 occurred in 23 of 55 patients, with two deaths from toxicity, and two patients did not have TEM or major surgery. Among 47 patients who had TEM, ypT0–1 disease was found in 30, ypT0 N1 in one, ypT2 in 15 and ypT3 in one. Local recurrence developed in three of the nine patients with ypT2 tumours who declined further surgery. Postoperative complications grade I–IIIb occurred in 13 of 47 patients after TEM and in five of 12 after (completion) surgery. After a median follow-up of 17 months, four local recurrences had developed overall, three in patients with ypT2 and one with ypT1 disease. Conclusion TEM after chemoradiotherapy enabled organ preservation in one-half of the patients with rectal cancer.
Databáze: OpenAIRE
Externí odkaz: