The impact of total neo-adjuvant treatment on nonoperative management in patients with locally advanced rectal cancer: The evaluation of 66 cases
The impact of total neo-adjuvant treatment on nonoperative management in patients with locally advanced rectal cancer: The evaluation of 66 cases
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DOI：
10.1016/j.ejso.2019.07.012
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发表时间：
2020-03-01
期刊：
影响因子：
3.8
通讯作者：
Guven, Koray
中科院分区：
文献类型：
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作者：
Asoglu, Oktar;Tokmak, Handan;Guven, Koray
背景：该研究旨在评估是否坚持总新辅助治疗（TNT）方案，然后观察（观察和等待）导致成功的非手术治疗低位直肠癌。方法：本研究对原发、可切除的t3 - t4、N0-N1型远端直肠腺癌患者进行放化疗、刺巩固化疗（TNT）。在tnt期间，行内窥镜、MRI、FDG-PET/CT检查。我们将临床肿瘤完全消退的患者分配到观察组（OG），这些患者在治疗后每两个月进行一次内窥镜检查，每四个月进行一次MRI检查，每六个月进行一次PET/CT检查。其他所有患者均转介手术。OG被跟踪了。主要终点是分配到OG后的局部肿瘤复发。结果：在2015年至2018年期间，我们招募了66名患者。在60例符合条件的患者中，39例具有完全临床反应（cCR）并被分配到OG， 6例进行了局部切除（LE）， 15例进行了全肠系膜切除（TME）。中位随访时间为22（9-42）个月。OG组局部复发率为15.3%，LE和TME分别为16.6%和0%。所有复发病例均通过LE或TME抢救。OG组、LE组和TME组的远处转移率分别为5.1%、16.6%和12.5%。手术组（LE thorn TME）内镜下阴性预测值（NPV）为50%，阳性预测值（PPV）为76.9%。核磁共振;ppv npv - 50% - 76.9%。PET / CT;ppv npv - 100% - 93.3%。手术组有6例（28.57%）患者达到完全病理缓解（cPR）。结论：我们的研究结果表明，在新辅助治疗后，有很大比例的选择性ccr直肠癌可以通过非手术治疗，并且可以避免大手术。(C) 2019爱思唯尔有限公司，BASO类似于癌症外科协会和欧洲外科肿瘤学会。版权所有。
Background: The study aimed to assess if adherence to a total-neoadjuvant-treatment (TNT) protocol followed by observation(watch-and-wait) led to the successful nonoperative-management of low-rectal-cancer.Methods: In this study, patients with primary, resectable-T3-T4, N0-N1 distal-rectal-adenocarcinoma underwent-chemoradiotherapy thorn consolidation-chemotherapy (TNT). During the-TNT-period, endoscopy, MRI, and FDG-PET/CT were performed. We allocated patients with complete-clinical-tumor-regression, who underwent endoscopy every two months, MRI every-four-months, and PET/CT everysix-months-after-treatment, to the observation-group(OG). All other patients were referred for surgery. The OG was followed-up. The primary endpoint was local tumor-ecurrence after allocation to the OG.Results: Between 2015 and 2018, we enrolled 66-patients. Of 60-patients who were eligible to participate, 39 had complete-clinical-response(cCR) and were allocated to the OG, six underwent local-excision (LE), and 15 underwent total-mesorectal-excision (TME). The median follow-up duration was 22 (9-42) months. The local-recurrence-rate in the OG was 15.3%, and the LE and TME rates were 16.6% and 0%, respectively. All recurrence cases were salvaged through either LE or TME. The-distant-metastasis rate was 5.1%, 16.6%, and 12.5% in the OG, LE, and TME groups, respectively. The endoscopic negative-predictive-value(NPV) was 50%, and the positive-predictive-value(PPV) was 76.9% in the surgery group (LE thorn TME). MRI; NPV-50%, PPV-76.9%. PET/CT; NPV-100%, PPV-93.3%. Six patients(28.57%) from surgery group achieved complete pathological response (cPR).Conclusion: Our results indicated a high proportion of selected-rectal-cancers with-cCR after neoadjuvant-therapy could potentially be managed non-operatively, and major surgery may be avoided. (C) 2019 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.