Neoadjuvant chemotherapy and high-dose radiation using intensity-modulated radiotherapy followed by rectal sparing TEM for distal rectal cancer
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For distal rectal tumors, abdominoperineal resection may achieve local control but with significant morbidity. High-dose radiation can improve pathologic response and allow for full-thickness local excision (FTLE) with comparable outcomes and improved morbidity. We report 15 years of data on distal rectal cancer treated with chemotherapy, intensity-modulated radiotherapy (IMRT), and FTLE via transanal endoscopic microsurgery.
Methods and materials
Forty-four patients were treated for cT1–T3, N0, and M0 distal rectal cancer using IMRT at 5580 cGy with 5-FU chemotherapy, followed by FTLE. Local recurrence (LR), disease-free survival (DFS), and overall survival (OS) were reported.
Median follow-up was 51 months. Three patients (6.8%) had LR, all salvaged surgically. Mean DFS and OS are 8.56 and 9.10 years, respectively. DFS and OS were strongly associated with pathologic response to chemoradiotherapy (p = 0.043 and p = 0.023, respectively). Thirty-four patients (77%) are alive with no disease. Postoperative grade I–II complications noted in 17 patients and grade III complications in 2 patients. No patients required a diverting colostomy.
High-dose IMRT and chemotherapy followed by FTLE to treat distal rectal cancers are well tolerated and effective. FTLE may improve outcomes and minimize complications in appropriately selected patients. Randomized clinical trials are needed to compare it with standard surgery.
KeywordsTransanal endoscopic microsurgery Intensity-modulated radiotherapy Distal rectal cancer Full-thickness local excision for rectal cancer Abdominoperineal resection for rectal cancer High-dose radiation for rectal cancer Rectal neoplasm
Compliance with ethical standards
No funding was received for this study.
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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