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Preoperative combined modality therapy for clinically resectable uT3 rectal adenocarcinoma
1Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Summary
Preoperative combined modality therapy for rectal cancer showed low toxicity and high rates of sphincter preservation (89%) and survival (95% at 3 years). This approach is a viable alternative for uT3 rectal adenocarcinoma.
Area of Science:
- Oncology
- Surgical Oncology
- Radiation Oncology
Background:
- Rectal adenocarcinoma poses significant treatment challenges, particularly for uT3 tumors.
- Combined modality therapy (CMT) is increasingly explored for improved outcomes.
Purpose of the Study:
- To evaluate acute toxicity, patient outcomes, and sphincter preservation rates.
- To assess the efficacy of preoperative CMT for resectable uT3 rectal cancer.
Main Methods:
- 72 patients with uT3 rectal cancer received preoperative chemoradiation (50.4 Gy, 5-FU/leucovorin) followed by surgery.
- Postoperative chemotherapy (5-FU/leucovorin) was administered.
- Outcomes included toxicity, complete response (CR), sphincter preservation, function, and survival.
Main Results:
- Grade 3+ toxicity occurred in 28% of patients.
- Pathologic CR rate was 13%, with an additional 9% clinical CR (total 22%).
- Sphincter preservation was achieved in 89% of patients requiring it, with 81% having good-to-excellent function. 3-year survival was 95% with low local recurrence (2%).
Conclusions:
- Preoperative CMT demonstrates favorable acute toxicity profiles.
- Encouraging rates of local control, survival, and sphincter preservation support its use.
- This approach offers an alternative for resectable uT3 rectal cancer treatment.