title: Influence of Preoperative Chemoradiotherapy on the Surgical Strategy According to the Clinical T Stage of Patients With Rectal Cancer.
abstract: The aim of this study was to evaluate the pathologic responses and changes to surgical strategies following preoperative chemoradiotherapy (PCRT) in rectal cancer patients according to their clinical T stage (cT).The use of PCRT has recently been extended to less advanced disease.The authors enrolled 650 patients with cT2 to 4 mid and low rectal cancer who received both PCRT and surgical resection. The rate of total regression and the proportion of local excision were compared according to the cT category. The 3-year recurrence-free survival (RFS) rate was compared using the log-rank test according to patient cT category, pathologic stage, and type of surgical treatment.Patients with cT2 were older (P = 0.001), predominately female (P = 0.028), and had low-lying rectal cancer (P = 0.008). Pathologic total regression was achieved most frequently in cT2 patients (54% of cT2 versus 17.6% of cT3 versus 8.2% of cT4; P < 0.001). Local excision was performed on 42 cT2 (42%) and 24 cT3 (5.2%) patients (P < 0.001). The 3-year RFS rates differed according to both cT (P < 0.001) and ypT stage (P < 0.001). Among patients with ypT0 to 1 disease, the 3-year RFS did not differ according to the type of surgical treatment received (P = 0.5).Total regression of the primary tumor and a change in the surgical strategy after PCRT are most commonly seen in cT2 disease. Although PCRT is not generally indicated for cT2 rectal cancer, optimal surgical treatment may be achieved with the tailored use of PCRT.
authors.affiliation: From the Department of Colon and Rectal Surgery (IJP, JLL, YSY, CWK, S-BL, JCK); Department of Radiology (JSL, SHP); and Department of Radiation Oncology (JHP, JHK), University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea.
authors.forename: In Ja
authors.initials: IJ
authors.lastname: Park
authors.forename: Jong Lyul
authors.initials: JL
authors.lastname: Lee
authors.forename: Yong Sik
authors.initials: YS
authors.lastname: Yoon
authors.forename: Chan Wook
authors.initials: CW
authors.lastname: Kim
authors.forename: Seok-Byung
authors.initials: SB
authors.lastname: Lim
authors.forename: Jong Seok
authors.initials: JS
authors.lastname: Lee
authors.forename: Seong Ho
authors.initials: SH
authors.lastname: Park
authors.forename: Jin Hong
authors.initials: JH
authors.lastname: Park
authors.forename: Jong Hoon
authors.initials: JH
authors.lastname: Kim
authors.forename: Chang Sik
authors.initials: CS
authors.lastname: Yu
authors.forename: Jin Cheon
authors.initials: JC
authors.lastname: Kim
mesh_terms: D059248:Chemoradiotherapy / Q000379:methods; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011300:Preoperative Care / Q000379:methods; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D012007:Rectum / Q000473:pathology / Q000601:surgery