Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2005 May;241(5):829-36; discussion 836-8.
doi: 10.1097/01.sla.0000161980.46459.96.

Long-term oncologic outcome following preoperative combined modality therapy and total mesorectal excision of locally advanced rectal cancer

Jose G Guillem  1 , David B Chessin, Alfred M Cohen, Jinru Shia, Madhu Mazumdar, Warren Enker, Philip B Paty, Martin R Weiser, David Klimstra, Leonard Saltz, Bruce D Minsky, W Douglas Wong
Affiliations

Long-term oncologic outcome following preoperative combined modality therapy and total mesorectal excision of locally advanced rectal cancer

Jose G Guillem et al. Ann Surg. 2005 May.

Abstract

Objective: Our aims were to (1) determine the long-term oncologic outcome for patients with rectal cancer treated with preoperative combined modality therapy (CMT) followed by total mesorectal excision (TME), (2) identify factors predictive of oncologic outcome, and (3) determine the oncologic significance of the extent of pathologic tumor response.

Summary background data: Locally advanced (T3-4 and/or N1) rectal adenocarcinoma is commonly treated with preoperative CMT and TME. However, the long-term oncologic results of this approach and factors predictive of a durable outcome remain largely unknown.

Methods: Two hundred ninety-seven consecutive patients with locally advanced rectal adenocarcinoma at a median distance of 6 cm from the anal verge (range 0-15 cm) were treated with preoperative CMT (radiation: 5040 centi-Gray (cGy) and 5-fluorouracil (5-FU)-based chemotherapy) followed by TME from 1988 to 2002. A prospectively collected database was queried for long-term oncologic outcome and predictive clinicopathologic factors.

Results: With a median follow-up of 44 months, the estimated 10-year overall survival (OS) was 58% and 10 year recurrence-free survival (RFS) was 62%. On multivariate analysis, pathologic response >95%, lymphovascular invasion and/or perineural invasion (PNI), and positive lymph nodes were significantly associated with OS and RFS. Patients with a >95% pathologic response had a significantly improved OS (P = 0.003) and RFS (P = 0.002).

Conclusions: Treatment of locally advanced rectal cancer with preoperative CMT followed by TME can provide for a durable 10-year OS of 58% and RFS of 62%. Patients who achieve a >95% response to preoperative CMT have an improved long-term oncologic outcome, a novel finding that deserves further study.

PubMed Disclaimer

Figures

None
FIGURE 1. Five-year and 10-year overall survival of study population, with 95% confidence intervals.
None
FIGURE 2. Five-year and 10-year recurrence-free survival of study population, with 95% confidence intervals.
None
FIGURE 3. Comparison of overall survival between pCR (pathologic complete response, 100% response), near pCR (95%–99.9% response), and <95% pathologic response.
None
FIGURE 4. Comparison of recurrence-free survival between pCR (100% response), near pCR (95%–99.9% response), and <95% pathologic response.
See this image and copyright information in PMC

References

    1. Krook JE, Moertel CG, Gunderson LL, et al. Effective surgical adjuvant therapy for high-risk rectal carcinoma. N Engl J Med. 1991;324:709–715. - PubMed
    1. Prolongation of the disease-free interval in surgically treated rectal carcinoma: Gastrointestinal Tumor Study Group. N Engl J Med. 1985;312:1465–1472. - PubMed
    1. NIH consensus conference. Adjuvant therapy for patients with colon and rectal cancer. JAMA. 1990;264:1444–1450. - PubMed
    1. Grann A, Minsky BD, Cohen AM, et al. Preliminary results of preoperative 5-fluorouracil, low-dose leucovorin, and concurrent radiation therapy for clinically resectable T3 rectal cancer. Dis Colon Rectum. 1997;40:515–522. - PubMed
    1. Minsky BD, Cohen AM, Enker WE, et al. Preoperative 5-FU, low-dose leucovorin, and radiation therapy for locally advanced and unresectable rectal cancer. Int J Radiat Oncol Biol Phys. 1997;37:289–295. - PubMed

MeSH terms

LinkOut - more resources