Distal Rectal Cancer: Watchful Waiting & Chemo-Radiotherapy Might be Better Than Abdominoperineal Resection
Dr. Ane L. Appelt, PhD, from the Danish Colorectal Cancer Centre South at Vejle Hospital in Denmark, and colleagues have reported that better alternatives to abdominoperineal resection for patients with distal rectal cancer might be intensive watchful waiting and chemoradiotherapy as it can avoid undesirable outcomes and it is safe. This study was recently published in The Lancet Oncology.
Dr. Ane L. Appelt and colleagues explained in their study that patients with distal T2 or T3 rectal cancers are usually treated with abdominoperineal resection as it is the standard treatment. However, abdominoperineal resection is mutilating and extensive. Therefore, the focus of their study was to assess if the combination of concomitant chemotherapy with high-dose radiotherapy and watchful waiting was a better alternative and a success for conservative (non-surgical) management of low rectal cancer.
Dr. Ane L. Appelt and colleagues conducted their study on 55 patients with T2 or T3, N0 - N1 adenocarcinoma in the lower 6 cm of the rectum. Chemoradiotherapy was given to their tumor, elective lymph node volumes, and endo-rectal brachytherapy boost with additional oral tegafur-uracil. The oral tegafur-uracil was given for 6 weeks every day except on weekends. During treatment, and 6 weeks after treatment, endoscopies were done and biopsies were taken from the tumor at baseline. Once the patient has achieved no nodal or distant metastases on computed tomography and magnetic resonance imaging, negative tumor site biopsies, and clinical tumor regression 6 weeks after treatment, they are then observed further.
Forty patients had clinical complete response out of 51 patients who were eligible. They were allocated to observation. The median follow-up period for local recurrence in the observation group was 23.9 months. Fifteen and a half percent of the observation group experienced local recurrence at 1 year. Further details on the study result can be found here. Dr. van de Velde and Dr. Breugom who were uninvolved in the study expressed their concern for the risk of possible long-term adverse effects of intensive chemoradiotherapy followed by observation versus its benefit, especially those with clinical T2 rectal cancer not given neoadjuvant chemoradiotherapy.
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