NEW YORK (Reuters Health) Feb 18 - Certain patients with rectal cancer clinically staged as T3N0/N+ or T2N+ may not require chemoradiation before total mesorectal excision (TME), Spanish researchers report in a February 15th online paper in Cancer.
"Our data suggest that preoperative chemo-radiotherapy may be unnecessary in locally advanced rectal cancer, as long as the hypothetic margin of surgical resection appears free and no other adverse factors for local recurrence are present at the preoperative assessment," Dr. Matteo Frasson told Reuters Health by email.
"It is possible to obtain a curative resection of the rectal cancer without preoperative chemo-radiotherapy in a large number of patients, avoiding radiation overtreatment and reducing complications such as sexual dysfunction and anal incontinence," he added.
Dr. Frasson and colleagues at the University of Valencia note that TME has cut local recurrence rates and they sought to determine the impact of preoperative treatment.
The team studied 398 patients, 152 who didn't undergo chemoradiation before TME. They were followed for a median of 39 months.
The 5-year overall actuarial local recurrence was 9.5%. Disease-free survival was 65.4% and cancer-specific survival was 77.8%. Threatened mesorectal fascia at preoperative staging was the only independent preoperative factor that predicted a significantly worse outcome in regard to these measures.
The 5-year local recurrence rate for patients with preoperatively threatened circumferential resection margins was 19.4%, compared to 5.4% in those without such findings.
The researchers conclude that patients with a free margin of more than 2 mm from the mesorectal fascia may undergo TME alone.
Thus, concluded Dr. Frasson, "The widely accepted practice of indicating neoadjuvant therapy for all locally advanced rectal cancers should be further re-evaluated in large prospective trials."
Cancer. Posted online February 15, 2011. Abstract
"Our data suggest that preoperative chemo-radiotherapy may be unnecessary in locally advanced rectal cancer, as long as the hypothetic margin of surgical resection appears free and no other adverse factors for local recurrence are present at the preoperative assessment," Dr. Matteo Frasson told Reuters Health by email.
"It is possible to obtain a curative resection of the rectal cancer without preoperative chemo-radiotherapy in a large number of patients, avoiding radiation overtreatment and reducing complications such as sexual dysfunction and anal incontinence," he added.
Dr. Frasson and colleagues at the University of Valencia note that TME has cut local recurrence rates and they sought to determine the impact of preoperative treatment.
The team studied 398 patients, 152 who didn't undergo chemoradiation before TME. They were followed for a median of 39 months.
The 5-year overall actuarial local recurrence was 9.5%. Disease-free survival was 65.4% and cancer-specific survival was 77.8%. Threatened mesorectal fascia at preoperative staging was the only independent preoperative factor that predicted a significantly worse outcome in regard to these measures.
The 5-year local recurrence rate for patients with preoperatively threatened circumferential resection margins was 19.4%, compared to 5.4% in those without such findings.
The researchers conclude that patients with a free margin of more than 2 mm from the mesorectal fascia may undergo TME alone.
Thus, concluded Dr. Frasson, "The widely accepted practice of indicating neoadjuvant therapy for all locally advanced rectal cancers should be further re-evaluated in large prospective trials."
Cancer. Posted online February 15, 2011. Abstract
Δεν υπάρχουν σχόλια:
Δημοσίευση σχολίου