Non-surgical management of rectal cancer. Series of 68 cases, long follow up in two leading centres in Argentina.
BACKGROUND
The non-surgical management in a selected group of rectal cancer patients has shown promising results with adequate follow up.


OBJECTIVE
describing the results of the non-surgical management in patients with complete clinical response, with a close follow up.


METHODS
Between 2006 and 2015, patients with rectal cancer, stages I-III, without metastasis, treated with neoadjuvant CRT/CT, who had clinical complete response were included. CCR was defined through digital palpation, endoscopy-based criteria and MRI. Follow up was set according to institutional guidelines.


RESULTS
68 patients were included. Initial stage was assessed with MRI in 55/68 pts and EUS 11/68. Considering the recurrence risk factors 57.6% (29/68) were T2-3ab N0, 3.3% (2/68) were T4N0, 29% (20/68) were T3-4 N1-2, with 39.7% with positive MRC. Mean distance to the anal margin was 3cm. Chemoradiation included radiotherapy at 50.4cGy, and concurrent capecitabine. In 22% a fluoropirimidine and oxaliplatin-based schema was used as induction therapy. Median follow up was 37.5 months and response assessment time 9 weeks (5-19). Eleven patients recurred, 6 endoluminally, 3 developed mesorectal recurrence, and two distant failure. Five years DFS and OS were 76.3% and 93.8%.


CONCLUSIONS
conservative management was feasible with close follow up in leading cancer centres. In this series, DFS and OS were comparable to the data already reported in the literature.
Surgical Oncology Instituto Alexander Fleming, Buenos Aires, Argentina. Electronic address: fsanchez@intramed.net.
Fernando
F
Sanchez Loria
Hospital de Gastroenterologia Bonorino Udaondo, Buenos Aires, Argentina. Electronic address: iseassoledad@hotmail.com.
Soledad
S
Iseas
Clinical Oncology Instituto Alexander Fleming, Buenos Aires, Argentina. Electronic address: juanmanuel.oconnor@gmail.com.
Juan Manuel
JM
O'Connor
Surgical Oncology Instituto Alexander Fleming, Buenos Aires, Argentina. Electronic address: apairola@yahoo.com.
Alejandro
A
Pairola
Clinical Oncology Instituto Alexander Fleming, Buenos Aires, Argentina. Electronic address: matiemi@yahoo.com.
Matias
M
Chacon
Hospital de Gastroenterologia Bonorino Udaondo, Buenos Aires, Argentina. Electronic address: mendezdoc@hotmail.com.
Guillermo
G
Mendez
Hospital de Gastroenterologia Bonorino Udaondo, Buenos Aires, Argentina. Electronic address: mcoraglio@hotmail.com.
Mariana
M
Coraglio
Statistitian Instituto Alexander Fleming, Buenos Aires, Argentina. Electronic address: ja_mariani@hotmail.com.
Javier
J
Mariani
Imagenologist Diagnostico Medico, Buenos Aires, Argentina. Electronic address: amdieguez@speedy.com.ar.
Adriana
A
Dieguez
Hospital de Gastroenterologia Bonorino Udaondo, Buenos Aires, Argentina. Electronic address: enlroca@yahoo.com.ar.
Enrique
E
Roca
Surgical Oncology Instituto Alexander Fleming, Buenos Aires, Argentina. Electronic address: huertaseduardo@yahoo.com.ar.
Eduardo
E
Huertas
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001118:Argentina; D059248:Chemoradiotherapy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D012004:Rectal Neoplasms / Q000628:therapy*; D012189:Retrospective Studies
D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D005472:Fluorouracil
Complete response; Neoadjuvant chemoradiation; Organ preserving; Rectal cancer