title: Long-term outcome of patients with complete pathologic response after neoadjuvant chemoradiation for cT3 rectal cancer: implications for local excision surgical strategies.
abstract: BACKGROUND
  Neoadjuvant chemoradiotherapy (CRT) followed by radical surgery including total mesorectal excision (TME) is standard treatment in patients with locally advanced rectal cancer. Emerging data indicate that patients with complete pathologic response (ypCR) after CRT have favorable outcome, suggesting the possibility of less invasive surgical treatment. We analyzed long-term outcome of cT3 rectal cancer treated by neoadjuvant CRT in relation to ypCR and type of surgery.
  
  
  METHODS
  The study population comprised 139 patients (93 men, 46 women; median age 62 years) with cT3N0-1M0 mid and distal rectal adenocarcinoma treated by CRT and surgery (110 TME and 29 local excision) at our institution between 1996 and 2008. At pathology, ypCR was defined as no residual cancer cells in the primary tumor.
  
  
  RESULTS
  Tumors of 42 patients (30.2%) were classified as ypCR. After a median follow-up of 55.4 months, comparing patients with ypCR to patients with no ypCR, 5-year disease-specific survival was 95.8% versus 78.0% (P = 0.004), and 5-year disease-free survival was 90.1% vs. 64.0% (P = 0.004). In patients with ypCR, no statistically significant outcome difference was observed between TME and local excision. In patients treated by local excision, comparing patients with ypCR to patients with no ypCR, 5-year disease-free survival was 100% vs. 65.5% (P = 0.024), and 5-year local recurrence-free survival was 92.9% vs. 66.7% (P = 0.047).
  
  
  CONCLUSIONS
  With retrospective analysis limitations, our data confirm favorable long-term outcome of cT3 rectal cancer with ypCR after CRT and warrant clinical trials exploring local excision surgical strategies.
authors.affiliation: Department of Surgical Oncology, CRO-IRCCS, National Cancer Institute, Aviano, Italy. cbelluco@cro.it
authors.forename: Claudio
authors.initials: C
authors.lastname: Belluco
authors.forename: Antonino
authors.initials: A
authors.lastname: De Paoli
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Canzonieri
authors.forename: Roberto
authors.initials: R
authors.lastname: Sigon
authors.forename: Mara
authors.initials: M
authors.lastname: Fornasarig
authors.forename: Angela
authors.initials: A
authors.lastname: Buonadonna
authors.forename: Giovanni
authors.initials: G
authors.lastname: Boz
authors.forename: Roberto
authors.initials: R
authors.lastname: Innocente
authors.forename: Tiziana
authors.initials: T
authors.lastname: Perin
authors.forename: Marta
authors.initials: M
authors.lastname: Cossaro
authors.forename: Jerry
authors.initials: J
authors.lastname: Polesel
authors.forename: Francesco
authors.initials: F
authors.lastname: De Marchi
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D013505:Digestive System Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D015996:Survival Rate