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Title: Adjuvant therapy sparing in rectal cancer achieving complete response after chemoradiation
Author: García-Albéniz, Xavier
Gallego, Rosa
Hofhteinz, Ralf Dieter
Fernández Esparrach, Glòria
Ayuso-Colella, Juan Ramón
Bombí, Josep Antoni
Conill, Carles
Cuatrecasas Freixas, Miriam
Delgado Rivilla, Salvadora
Ginès i Gibert, M. Àngels
Miquel Morera, Rosa
Pagès Llinàs, M. (Mario)
Pineda, Estela
Pereira, Verónica
Sosa, Aarón
Reig, Oscar
Victoria, Iván
Feliz, Luis
Lacy Fortuny, Antonio Ma. de
Castells Garangou, Antoni
Burkholder, Iris
Hochhaus, Andreas
Maurel Santasusana, Joan
Keywords: Càncer colorectal
Quimioteràpia del càncer
Cirurgia laparoscòpica
Estudi de casos
Colorectal cancer
Cancer chemotherapy
Laparoscopic surgery
Case studies
Issue Date: 14-Nov-2014
Publisher: Baishideng Publishing Group
Abstract: AIM: To evaluate the long-term results of conventional chemoradiotherapy and laparoscopic mesorectal excision in rectal adenocarcinoma patients without adjuvant therapy. METHODS: Patients with biopsy-proven adenocarcinoma of the rectum staged cT3-T4 by endoscopic ultrasound or magnetic resonance imaging received neoadjuvant continuous infusion of 5-fluorouracil for five weeks and concomitant radiotherapy. Laparoscopic surgery was planned after 5-8 wk. Patients diagnosed with ypT0N0 stage cancer were not treated with adjuvant therapy according to the protocol. Patients with ypT1-2N0 or ypT3-4 or N+ were offered 5-fluorouracil-based adjuvant treatment on an individual basis. An external cohort was used as a reference for the findings. RESULTS: One hundred and seventy six patients were treated with induction chemoradiotherapy and 170 underwent total mesorectal excision. Cancer staging of ypT0N0 was achieved in 26/170 (15.3%) patients. After a median follow-up of 58.3 mo, patients with ypT0N0 had five-year disease-free and overall survival rates of 96% (95%CI: 77-99) and 100%, respectively. We provide evidence about the natural history of patients with localized rectal cancer achieving a complete response after preoperative chemoradiation. The inherent good prognosis of these patients will have implications for clinical trial design and care of patients. CONCLUSION: Withholding adjuvant chemotherapy after complete response following standard neoadjuvant chemoradiotherapy and laparoscopic mesorectal excision might be safe within an experienced multidisciplinary team.
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It is part of: World Journal of Gastroenterology, 2014, vol. 20, num. 42, p. 15820-15829
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ISSN: 1007-9327
Appears in Collections:Articles publicats en revistes (Medicina)
Articles publicats en revistes (Fonaments Clínics)
Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)

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