title: Nonoperative management of rectal cancer with complete clinical response after neoadjuvant therapy.
abstract: BACKGROUND
  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).
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
authors.forename: James D
authors.initials: JD
authors.lastname: Smith
authors.forename: Jeannine A
authors.initials: JA
authors.lastname: Ruby
authors.forename: Karyn A
authors.initials: KA
authors.lastname: Goodman
authors.forename: Leonard B
authors.initials: LB
authors.lastname: Saltz
authors.forename: José G
authors.initials: JG
authors.lastname: Guillem
authors.forename: Martin R
authors.initials: MR
authors.lastname: Weiser
authors.forename: Larissa K
authors.initials: LK
authors.lastname: Temple
authors.forename: Garrett M
authors.initials: GM
authors.lastname: Nash
authors.forename: Philip B
authors.initials: PB
authors.lastname: Paty
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000532:radiotherapy*; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D012189:Retrospective Studies; D016896:Treatment Outcome