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      Clinical T2N0 Rectal Cancer Treated with Neoadjuvant Chemoradiotherapy plus Local Excision

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          Abstract

          Introduction: Total mesorectal excision is the standard treatment for clinical T2 (cT2) rectal cancer; however, this procedure can result in postoperative dysfunction, decreased quality of life, and stoma creation in some patients. We investigated neoadjuvant chemoradiotherapy (nCRT) plus local excision (LE) as an alternative treatment strategy for patients with cT2N0 rectal cancer. Method: Fifty-six patients with cT2N0M0 rectal cancer who exhibited the following characteristics (an anal verge of ≤8 cm, tumor size of <30 mm, well- or moderately differentiated adenocarcinoma on biopsy) underwent LE following nCRT. Chemoradiotherapy was administered at 40 or 45 Gy in 20–25 fractions with concurrent oral UFT (tegafur/uracil; 400 mg/m<sup>2</sup>) or S-1 (tegafur/gimeracil/oteracil; 80 mg/m<sup>2</sup>). Results: Fifty-five patients (98%) completed nCRT as planned. Histologically, the excision margin was negative in all patients, and four patients with ypT3 disease underwent total mesorectal excision. Recurrence was observed in 15 patients (27%), local recurrence in 7 (13%), and distant recurrence in 10 (18%). The salvage surgery was possible for the local recurrence group. The 5-year disease-free and overall survival rates were 68.4% and 84.9%, respectively. Multivariate analysis showed that only the tumor regression grade (TRG) was an independent risk factor for recurrence ( p = 0.025). Although 7 (26%) out of 27 patients with a TRG of 3 or 4 developed local recurrence and 6 (22%) had distant metastasis, 25 patients with a TRG of 1 or 2 did not exhibit local recurrence, and only 1 (4%) experienced distant metastasis. Conclusion: nCRT plus LE may be an alternative treatment for patients with cT2N0 rectal cancer who achieved a TRG of 1 or 2. However, additional treatment was required in patients who achieved a TRG of 3 or 4.

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          Author and article information

          Journal
          OCL
          Oncology
          10.1159/issn.0030-2414
          Oncology
          Oncology
          S. Karger AG
          0030-2414
          1423-0232
          2023
          March 2023
          28 October 2022
          : 101
          : 3
          : 166-172
          Affiliations
          Department of Surgery, Tokai University School of Medicine, Kanagawa, Japan
          Author information
          https://orcid.org/0000-0002-7800-3880
          https://orcid.org/0000-0001-9819-5149
          https://orcid.org/0000-0002-9879-1239
          Article
          527137 Oncology 2023;101:166–172
          10.1159/000527137
          36310019
          d2d2a16e-549d-4550-acf4-d92a13317c59
          © 2022 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.

          History
          : 14 July 2022
          : 13 September 2022
          Page count
          Figures: 1, Tables: 4, Pages: 7
          Funding
          The authors did not receive any funding.
          Categories
          Clinical Study

          Medicine
          Local excision,T2 rectal cancer,Chemoradiotherapy
          Medicine
          Local excision, T2 rectal cancer, Chemoradiotherapy

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