| Early patients with low rectal cancer after neoadjuvant therapy was not CR surgery |
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| Written by Thomas Cutler | |
| Friday, 27 July 2007 | |
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Early patients with low rectal cancer after neoadjuvant therapy was not CR surgery Angelita School of Medicine in Sao Paulo, Brazil, for patients with low rectal cancer early in the clinical radiotherapy and chemotherapy achieved complete remission (CR) after surgical treatment may unnecessarily. (Ann Surg 2004,240:711) The study into low rectal adenocarcinoma, and non-resectable of distant metastasis in patients with 265 cases. Patients receive neoadjuvant chemotherapy and radiotherapy, radiotherapy total dose of 5040 cGy, in the three days before radiotherapy after three days of receiving folic acid and 5-fluorouracil treatment. Researchers on the CR patients will no longer be under close follow-up surgery; CR to the absence of further surgery, including abdominal-perineal resection, low colon and rectum or colon anal anastomosis, in order to achieve 0 mitigation. Postoperative follow-up to the close. For relapsed patients, adjuvant treatment of the remaining patients will no longer be treated. The results show that 26.8% (71/265 cases) after radiotherapy and chemotherapy in patients with CR, points to the observation group was no longer carry out further surgery. 73.2% (194/265 patients) in patients after chemotherapy and radiotherapy for clinical CR and not to resection, 8.3% (22/265 cases) for pT0N0M0 resected specimen pathology. Observer Group, the average follow-up period of 57.3 months, three cases of metastasis and recurrence, two cases of rectal recurrence rate was 7.0%. 5-year and 10-year survival and disease-free survival rates were 100% and 92% and 100% and 86%. Resection group, the average follow-up period of 48 months, three cases of metastasis and recurrence, 2 patients died of recurrence and metastasis and recurrence rate was 13.6% and tumor mortality was 9%. 5-year survival rate and disease-free survival rates were 88% and 83%. Although the group did not die, the five-year survival rate is higher, but the relapse rate and the two groups no significant difference in mortality. Comprehensive results of the two groups, D0 of 10 patients with survival and disease-free survival rates were 97.7% and 84%. Angelita feel that regardless of what treatment strategy, the long-term effect of early colorectal cancer were good. After radiotherapy and chemotherapy in patients with a reasonable deal with the clinical evaluation of the CR should reach close follow-up, and can not improve surgical resection vesting, but will be temporarily or long-term impact of sphincter contraction and lead to unnecessary complications and death. Comments comprehensive treatment is considered low rectal cancer treatment strategy, the low rectal adenocarcinoma, and no resectability in patients with distant metastasis, at home and abroad to surgical resection is still the first choice, only some consider unresectable or estimates may not be radical resection patients, neoadjuvant chemotherapy and radiotherapy, so that these patients can be radical surgery and the opportunities. However, the findings can be said to be on the traditional treatment of subversion, it may be to change the low rectal cancer treatment strategy, we surgeon with completely different concepts to the face of such patients. This article should be read. |
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