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Published on: February 12, 2017
Good Responders to Rectal Cancer Neoadjuvant Chemotherapy, based on the MRI Findings Can Help to Avoid Radiotherapy:
Daisuke Kuwata1, Takuya Miura2, Hiromasa Fujita3
1Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki, 036-8216, Aomori, Japan.
Purpose:
To identify the prognostic factors in preoperatively treated rectal cancer and select patients who could be treated with neoadjuvant chemotherapy (NAC) alone.
Methods:
A total of 78 patients, 58 in the NAC group and 20 in the radiation therapy (RT) group, with rectal cancer deeper than cT3 or N+ were studied from 2016 to 2022. The survival outcomes after neoadjuvant therapy and poor prognostic factors were analyzed.
Results:
The median follow-up period was 63 months in the NAC group and 52 months in the RT group. In the multivariate analyses of all patients, a posttreatment mesorectal fascia (MRF)-positive status yielded a poor prognosis for the disease-free survival (HR, 5.051; 95% CI; 1.198-21.30, P = 0.027) and local recurrence (HR, 9.937; 95% CI; 1.282-77.05, P = 0.028). In posttreatment MRF-negative cases, the 3-year disease-free survival was 85.7% in both the NAC and RT groups (P = 0.950). The 3-year local recurrence rate was 14.3% in the RT group and 0% in the NAC group (P = 0.173).
Conclusions:
Posttreatment MRF positivity is an independent risk factor for a poor disease-free survival and local recurrence. However, posttreatment MRF negative cases that respond to NAC have comparable survival outcomes to those who undergo RT.
