Long-term Clinical Outcomes of Nonoperative Management with Chemoradiotherapy for Locally Advanced Rectal Cancer in the Veterans Health Administration
Menée à partir de données portant sur 1 313 patients atteints d'un cancer rectal de stade II à III (durée médiane de suivi : 67,2 mois), cette étude évalue, du point de vue de la survie spécifique et de la survie globale, la possibilité de ne pas planifier d'intervention chirurgicale après une chimioradiothérapie ayant induit une réponse clinique complète
Purpose : Standard therapy for locally advanced rectal cancer includes neoadjuvant chemoradiation and surgery. Complete response (CR) rates after chemoradiation can be as high as 29%, suggesting that nonoperative management (NOM) may be reasonable with appropriately selected patients. We sought to identify potential NOM candidates. Methods and Materials : Using the VA Central Cancer Registry, stage II-III rectal cancer patients receiving chemoradiation +/- subsequent surgery were identified. Clinical CR (cCR) was assessed by physical exam, endoscopy, and/or imaging. Kaplan-Meier and Log-Rank tests were used to assess survival; multivariate analysis was performed using Cox proportional hazards. Results : 1313 patients were identified. 313 received chemoradiation alone (CRT cohort); 1000 received chemoradiation followed by surgery (CRT+S cohort). Median follow-up was 67.2 months. Median overall survival (OS) was 68.5 months. Median OS was 30.6 months for CRT and 89.3 months for CRT+S (p< 0.001). Median disease-specific survival (DSS) was 44.8 months for CRT and not reached (NR) for CRT+S (p<0.001). 65 (20.8%) CRT patients had a cCR. Median OS for CRT cCR patients was 73.5 months (p=0.128 vs CRT+S); median DSS was NR (p=0.161 vs CRT+S). 137 (10.5%) CRT+S patients had a pathologic CR (pCR). Median OS with pCR was 133.7 months (p<0.001 vs CRT cCR), and median DSS was NR (p=0.276 vs CRT cCR). Conclusions : CRT patients with cCR had similar OS and DSS versus CRT+S patients and similar DSS versus CRT+S patients with a pCR. This suggests LARC patients with a cCR to CRT have an excellent prognosis and may be candidates for organ preservation.