Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
Ann Surg. 2012 Dec;256(6):965-72. doi: 10.1097/SLA.0b013e3182759f1c.
Nonoperative management (NOM) of rectal cancer after a complete clinical response (cCR) to neoadjuvant therapy is controversial. In this article, we retrospectively reviewed the outcomes of patients managed with selective NOM after a cCR to neoadjuvant treatment and compared these with patients who underwent standard rectal resection with a pathological complete response (pCR).
Patients completing neoadjuvant chemoradiotherapy (CRT) for stage I to III rectal cancer between January 2006 and August 2010 were retrospectively reviewed. Median follow-up was calculated in months after completion of CRT.
Thirty-two patients (median follow-up 28 months) were treated by NOM after a cCR. Among 265 treated by CRT and rectal resection, 57 patients (22%) had a pCR and formed the control group (median follow-up 43 months). Factors associated with selective use of NOM included lower pretreatment stage, older age, and distal tumor location (P < 0.05). In the NOM group, 6 recurred locally (median 11 months, range 7-14), 3 of whom also had concurrent distant recurrence. All 6 local failures were controlled by salvage rectal resection with no further local recurrence of disease (median follow-up 17 months). In the rectal resection/pCR group, there were no local failures. The 2-year distant disease-free survival (88% vs 98%, P = 0.27) and overall survival (96% vs 100%, P = 0.56) were similar for NOM and rectal resection/pCR groups.
Rectal resection was successfully avoided in 81% of patients selected for NOM. When combined with salvage surgery, NOM appears to achieve similar local and distant disease control compared with patients with a pCR treated by rectal resection. Longer follow-up and prospective trials are warranted to evaluate this promising treatment option.
新辅助治疗后完全临床缓解（cCR）的直肠癌的非手术治疗（NOM）存在争议。本文回顾性分析了接受 cCR 后接受选择性 NOM 治疗的患者的治疗结果，并与接受新辅助放化疗（CRT）和病理完全缓解（pCR）的标准直肠切除术患者进行比较。
回顾性分析 2006 年 1 月至 2010 年 8 月期间接受 I 至 III 期直肠癌新辅助 CRT 治疗的患者。中位随访时间为 CRT 完成后计算。
32 例（中位随访 28 个月）患者在 cCR 后接受 NOM 治疗。在 265 例接受 CRT 和直肠切除术的患者中，57 例（22%）获得 pCR 并形成对照组（中位随访 43 个月）。选择性使用 NOM 的相关因素包括较低的预处理分期、较年长和肿瘤位置较低（P < 0.05）。在 NOM 组中，6 例局部复发（中位时间为 11 个月，范围为 7-14 个月），其中 3 例同时出现远处复发。所有 6 例局部复发均通过挽救性直肠切除术控制，无疾病局部复发（中位随访 17 个月）。在直肠切除/pCR 组中，无局部复发。NOM 组和直肠切除/pCR 组的 2 年远处无病生存率（88% vs 98%，P = 0.27）和总生存率（96% vs 100%，P = 0.56）相似。
在选择接受 NOM 的患者中，81%的患者成功避免了直肠切除术。当与挽救性手术联合使用时，NOM 似乎与接受直肠切除和 pCR 治疗的患者具有相似的局部和远处疾病控制效果。需要更长时间的随访和前瞻性试验来评估这种有前途的治疗选择。
