title: Complete clinical response to neoadjuvant chemoradiation in rectal cancers: can surgery be avoided?
abstract: OBJECTIVE
  Neoadjuvant chemoradiation for rectal cancers may result in complete clinical response (cCR) in some patients. The aim of this study was to analyze the long-term outcomes of such patients in a tertiary cancer center.
  
  
  METHODS
  Patients with rectal cancer who had a cCR to neoadjuvant chemoradiation were divided into two groups: Group A (n=23) did not undergo surgery, and Group B (n=10) underwent elective surgery. The recurrence patterns and survival outcomes were compared between the two groups.
  
  
  RESULTS
  After a median follow-up of 72 months (range 12-180), seven patients (30%) in Group A developed an isolated local recurrence. In Group B, after a median follow-up of 37 months (range 12-180) there were no local recurrences. The median disease-free and overall survival was 36 months (range 6-168) and 66 months (range 12-180) in Group A and 36 months (range 12-180) and 37 months (range 18-180) in Group B respectively.
  
  
  CONCLUSIONS
  Our results suggest that surgery could be avoided in selected patients with rectal cancer who have a cCR to neoadjuvant chemoradiation. However, until the safety of a non-surgical approach is proven in a prospective randomized trial, it cannot be recommended outside a clinical protocol study.
authors: Department of Surgical Oncology, Cancer Institute (WIA), Chennai, India. ram_a_s@yahoo.com
authors: Ramakrishnan
authors: R
authors: Ayloor Seshadri
authors: Satish S
authors: SS
authors: Kondaveeti
authors: Sunil Bhanu
authors: SB
authors: Jayanand
authors: Alexander
authors: A
authors: John
authors: Rejiv
authors: R
authors: Rajendranath
authors: Vasanthan
authors: V
authors: Arumugam
authors: Hemanth
authors: H
authors: Raj Ellusamy
authors: Tenali Gnana
authors: TG
authors: Sagar
mesh_terms: D000328:Adult; D000368:Aged; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000401:mortality; D009364:Neoplasm Recurrence, Local; D018579:Patient Selection; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D012074:Remission Induction; D012189:Retrospective Studies; D016019:Survival Analysis; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome