title: Nonoperative management of rectal cancer after chemoradiation opposed to resection after complete clinical response. A comparative study.
abstract: BACKGROUND
  Surgery is the standard treatment of rectal cancer after neoadjuvant therapy. Some authors advocate a nonoperative management (NOM) after complete clinical response (cCR) following chemoradiotherapy (CRT). We compare our results with NOM to standard resection in a retrospective analysis.
  
  
  METHODS
  Rectal adenocarcinomas submitted to NOM after CRT between September 2002 and December 2013 were compared to surgical patients that had pathological complete response (pCR) during the same period. Endpoints were Overall Survival (OS), Disease Free Survival (DFS), Local Relapse (LR) and Distant Relapse (DR).
  
  
  RESULTS
  Forty-two NOM patients compared to 69 pCR patients operated after a median interval of 35 weeks after CRT. NOM tumors were distal (83.3% vs 59.4%, p = 0.011), less obstructive (26.2% vs 54.4%, p = 0.005) and had a lower digital rectal score (p = 0.024). Twelve (28.0%) recurrences in NOM group and eight (11.5%) in the surgical group occurred after a follow-up of 47.7 and 46.7 months respectively. Isolated LR occurred in five (11%) NOM patients and one (1.4%) in the surgical group. Four (80%) LR were surgically salvaged in NOM group. No difference in OS was found (71.6% vs 89.9%, p = 0.316) but there was a higher DFS favoring surgical group (60.9% vs 82.8%, p = 0.011). Distal tumors had worse OS compared to proximal tumors in surgical group (5-year OS of 85.5% vs 96.2%, p = 0.038).
  
  
  CONCLUSIONS
  The NOM achieved OS comparable to surgical treatment and spared patients from surgical morbidity but it resulted in more recurrences. This approach cannot be advocated routinely and controlled trials are warranted.
authors.affiliation: Department of Abdominal and Pelvic Surgery, National Institute of Cancer - INCA, Rio de Janeiro, Brazil. Electronic address: raraujooncologia@gmail.com.
authors.forename: R O C
authors.initials: RO
authors.lastname: Araujo
authors.affiliation: Department of Abdominal and Pelvic Surgery, National Institute of Cancer - INCA, Rio de Janeiro, Brazil.
authors.forename: M
authors.initials: M
authors.lastname: Valadão
authors.affiliation: Department of Abdominal and Pelvic Surgery, National Institute of Cancer - INCA, Rio de Janeiro, Brazil.
authors.forename: D
authors.initials: D
authors.lastname: Borges
authors.affiliation: Department of Abdominal and Pelvic Surgery, National Institute of Cancer - INCA, Rio de Janeiro, Brazil.
authors.forename: E
authors.initials: E
authors.lastname: Linhares
authors.affiliation: Department of Abdominal and Pelvic Surgery, National Institute of Cancer - INCA, Rio de Janeiro, Brazil.
authors.forename: J P
authors.initials: JP
authors.lastname: de Jesus
authors.affiliation: Clinical Oncology and Applied Research Centre, National Institute of Cancer - INCA, Rio de Janeiro, Brazil.
authors.forename: C G
authors.initials: CG
authors.lastname: Ferreira
authors.affiliation: Clinical Oncology and Applied Research Centre, National Institute of Cancer - INCA, Rio de Janeiro, Brazil.
authors.forename: A P
authors.initials: AP
authors.lastname: Victorino
authors.affiliation: Clínicas Oncológicas Integradas - COI, Rio de Janeiro, Brazil.
authors.forename: F M
authors.initials: FM
authors.lastname: Vieira
authors.affiliation: Department of Abdominal and Pelvic Surgery, National Institute of Cancer - INCA, Rio de Janeiro, Brazil.
authors.forename: R
authors.initials: R
authors.lastname: Albagli
mesh_terms: D000230:Adenocarcinoma / Q000628:therapy*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D059248:Chemoradiotherapy / Q000379:methods; D003082:Colectomy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D012004:Rectal Neoplasms / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents
keywords: Complete clinical response; Neoadjuvant therapy; Nonoperative treatment; Rectal cancer; Rectal resection