Further evidence for preoperative chemoradiotherapy and transanal endoscopic surgery (TEM) in T2-3s,N0,M0 rectal cancer.
OBJECTIVE
Preoperative chemoradiotherapy and local excision via transanal endoscopic surgery (TEM) in T2-3s,N0,M0 rectal cancer achieve promising results in selected patients. We describe our long-term follow-up experience with this combination, and evaluate complete clinical and pathological responses, local recurrence and overall survival.


METHODS
The prospective observational follow-up study carried out since 2007. Out of 476 consecutive patients treated with TEM, we selected those with adenocarcinoma of low or moderate grade of differentiation, clinical stages T2-superficial T3,N0,M0, who refused radical surgery. Preoperative chemoradiotherapy comprised 5-fluorouracil or capecitabine combined with radiotherapy at a dose of 50.4 Gy. TEM was performed after 8 weeks. Complications were recorded and long-term follow-up was conducted.


RESULTS
Fifteen patients undergoing preoperative chemoradiotherapy and TEM (median age 76 years, 95 % CI 70.3-80.4, and median follow-up 38 months, 95 % CI 20-44) were studied. No local recurrence was observed, and only one patient (6.7 %) presented systemic relapse. The overall survival was 76 %. Complete clinical response was achieved in seven patients (46.7 %) and complete pathological response in four (26.7 %). With regard to toxicity associated with neoadjuvant treatment, four patients (26.7 %) developed grade 3 adverse effects; no grade 4 or 5 adverse effects were observed. There was no postoperative mortality.


CONCLUSIONS
The results of our study, with a response rate of 26.7 % and without local relapse, support the treatment of T2-3s,N0,M0 of rectal cancer with preoperative chemoradiotherapy and local excision (TEM).
Medical Oncology Service, Parc Tauli University Hospital, Universidad Autonoma de Barcelona, Parc Tauli, no. 1, 08208, Sabadell, Barcelona, Spain. cpericay@gmail.com.
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Pericay
Coloproctology Unit, General and Digestive Surgery Service, Parc Tauli University Hospital, Universidad Autonoma de Barcelona, Sabadell, Barcelona, Spain.
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Serra-Aracil
Medical Oncology Service, Parc Tauli University Hospital, Universidad Autonoma de Barcelona, Parc Tauli, no. 1, 08208, Sabadell, Barcelona, Spain.
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Ocaña-Rojas
Coloproctology Unit, General and Digestive Surgery Service, Parc Tauli University Hospital, Universidad Autonoma de Barcelona, Sabadell, Barcelona, Spain.
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Mora-López
Medical Oncology Service, Parc Tauli University Hospital, Universidad Autonoma de Barcelona, Parc Tauli, no. 1, 08208, Sabadell, Barcelona, Spain.
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Dotor
Pathology Service, Parc Tauli University Hospital, Universidad Autonoma de Barcelona, Sabadell, Barcelona, Spain.
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Casalots
Medical Oncology Service, Parc Tauli University Hospital, Universidad Autonoma de Barcelona, Parc Tauli, no. 1, 08208, Sabadell, Barcelona, Spain.
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Pisa
Medical Oncology Service, Parc Tauli University Hospital, Universidad Autonoma de Barcelona, Parc Tauli, no. 1, 08208, Sabadell, Barcelona, Spain.
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Saigí
D000230:Adenocarcinoma / Q000401:mortality / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000069287:Capecitabine / Q000008:administration & dosage; D059248:Chemoradiotherapy; D059186:Chemoradiotherapy, Adjuvant / Q000379:methods*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000401:mortality / Q000628:therapy*; D000067368:Transanal Endoscopic Surgery / Q000379:methods*; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D000069287:Capecitabine; D005472:Fluorouracil
Preoperative chemoradioterapy; Rectal cancer; TEM