Rate of pathologic complete response with increased interval between preoperative combined modality therapy and rectal cancer resection.
BACKGROUND
Recent data suggest a favorable prognosis for rectal cancer patients with a pathologic complete response to preoperative combined modality therapy. Prolongation of the interval between preoperative combined modality therapy and surgery (RT-surgery interval) as a means of increasing pathologic complete response rate has not been fully examined.


METHODS
One hundred and fifty-five rectal cancer patients undergoing preoperative pelvic external beam radiation therapy and 5-fluorouracil-based chemotherapy followed by rectal resection were identified. All patients had endorectal ultrasound prior to combined modality therapy. Final pathology reports were reviewed for ypT and ypN stage and margin status. Medical records were reviewed for sphincter preservation, operative time, estimated blood loss, hospital stay, and morbidity (overall, anastomotic, and perineal).


RESULTS
A pathologic complete response (ypT0N0) occurred in 24 patients (15 percent). Median RT-surgery interval was 44 (range, 15-206) days. A pathologic complete response occurred in 19 percent of patients with an interval >44 days, vs. 12 percent in those with an interval < or =44 days ( P = 0.27). Downstaging by three stages occurred more frequently in the long-interval group (15 percent vs. 6 percent, P = 0.11). The rates of sphincter preservation, positive margins, estimated blood loss, and operative time were not significantly different. Overall morbidity was similar between groups.


CONCLUSIONS
Our results demonstrate a trend toward increased pathologic complete response rate and downstaging with increased RT-surgery interval. However, sphincter preservation is not increased. Until prospective analyses are conducted assessing the impact of prolonged RT-surgery interval on long-term outcome, the benefit of a prolonged interval between the completion of preoperative combined modality therapy and surgery remains unclear.
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Harvey G
HG
Moore
Alicia E
AE
Gittleman
Bruce D
BD
Minsky
Douglas
D
Wong
Philip B
PB
Paty
Martin
M
Weiser
Larissa
L
Temple
Leonard
L
Saltz
Jinru
J
Shia
Jose G
JG
Guillem
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000502:physiology / Q000601:surgery; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D003131:Combined Modality Therapy; D019160:Endosonography; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011300:Preoperative Care / Q000379:methods*; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors
D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil