학술논문
Surgical and short-term oncological safety of total neoadjuvant therapy in high-risk locally advanced rectal cancer.
Document Type
Academic Journal
Author
Ng YY; Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore.; Seow-En I; Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore.; Chok AY; Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore.; Lee TS; Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore.; Palanisamy P; Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore.; Tan EK; Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore.
Source
Publisher: Wiley-Blackwell Publishing Asia Country of Publication: Australia NLM ID: 101086634 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1445-2197 (Electronic) Linking ISSN: 14451433 NLM ISO Abbreviation: ANZ J Surg Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Management for locally advanced rectal cancer (LARC) conventionally comprises long-course chemoradiotherapy (LCCRT), total mesorectal excision (TME), and adjuvant chemotherapy. However, the RAPIDO study published in 2021 showed that total neoadjuvant therapy (TNT) led to better oncological outcomes without increased toxicity. We review the surgical and short-term oncological outcomes of patients with high-risk LARC who underwent TNT or LCCRT before TME.
Methods: Patients with high-risk LARC who underwent TNT or LCCRT before TME between 2021 and 2022 were reviewed.
Results: Thirty-five patients (66%) had TNT as per RAPIDO whilst 18 underwent LCCRT. Median follow-up was 16 months (range 5-25). Of the patients who had TNT, median age was 65 years old (range 44-79), 34 (97%) had clinical Stage 3 LARC and median height FAV was 5 cm (range 0.5-14). Nine (26%) required a dose delay/reduction due to treatment toxicity. Seven (50%) showed resolution of previously enlarged lateral nodes. Three (9%) had pathological complete response. Postoperative major morbidity was 23%, of which 4 patients required a reoperation. Six (17%) patients had disease-related treatment failure, with two having disease progression during TNT, two developed local recurrence, and two developed distal metastasis following surgery. Median duration to surgery following completion of chemotherapy was significantly shorter with TNT (36 days versus 74 days) (P < 0.001). There were no other significant differences in outcomes.
Conclusion: TNT is clinically safe in high-risk LARC patients with no significant difference to surgical and short-term oncological outcomes compared to LCCRT, although a higher incidence of early surgical morbidity was observed.
(© 2023 Royal Australasian College of Surgeons.)
Methods: Patients with high-risk LARC who underwent TNT or LCCRT before TME between 2021 and 2022 were reviewed.
Results: Thirty-five patients (66%) had TNT as per RAPIDO whilst 18 underwent LCCRT. Median follow-up was 16 months (range 5-25). Of the patients who had TNT, median age was 65 years old (range 44-79), 34 (97%) had clinical Stage 3 LARC and median height FAV was 5 cm (range 0.5-14). Nine (26%) required a dose delay/reduction due to treatment toxicity. Seven (50%) showed resolution of previously enlarged lateral nodes. Three (9%) had pathological complete response. Postoperative major morbidity was 23%, of which 4 patients required a reoperation. Six (17%) patients had disease-related treatment failure, with two having disease progression during TNT, two developed local recurrence, and two developed distal metastasis following surgery. Median duration to surgery following completion of chemotherapy was significantly shorter with TNT (36 days versus 74 days) (P < 0.001). There were no other significant differences in outcomes.
Conclusion: TNT is clinically safe in high-risk LARC patients with no significant difference to surgical and short-term oncological outcomes compared to LCCRT, although a higher incidence of early surgical morbidity was observed.
(© 2023 Royal Australasian College of Surgeons.)