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Session Item

Clinical track: Lower GI (colon, rectum, anus)
9306
Poster
Clinical
00:00 - 00:00
Major and complete response after neoadjuvant treatment in rectal cancer: a retrospective analysis
PO-1089

Abstract

Major and complete response after neoadjuvant treatment in rectal cancer: a retrospective analysis
Authors: Giraffa|, Martina(1)*[giraffamartina@gmail.com];Chiloiro|, Giuditta(2);Meldolesi|, Elisa(3);Corvari|, Barbara(3);Coco|, Claudio(4);Persiani|, Roberto(4);Sofo|, Luigi(4);Alfieri|, Sergio(4);Barbaro|, Brunella(2);Valentini|, Vincenzo(2);Gambacorta|, Maria Antonietta(2);
(1)Università Cattolica del Sacro Cuore, Dipartimento di Diagnostica per Immagini- Radioterapia Oncologica e Ematologia, Rome, Italy;(2)Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A.Gemelli IRCCS - Dipartimento di Diagnostica per Immagini- Radioterapia Oncologica e Ematologia, Rome, Italy;(3)Fondazione Policlinico Universitario A.Gemelli IRCCS, Dipartimento di Diagnostica per immagini - Radioterapia Oncologica ed Ematologia, Rome, Italy;(4)Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A.Gemelli IRCCS - Dipartimento di Chirurgia, Rome, Italy;
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Purpose or Objective

The conservative approach in locally advanced rectal cancer  (LARC)  patients (pts) who obtain a complete (CR) or major response (MR) after neoadjuvant radiochemotherapy (nCRT) is increasingly common. The objective of this study is to report the mono-istututional experience to evaluate the impact of a conservative approach on disease control after 3 years of follow-up (FUP).

Material and Methods

We analyzed LARC pts who obtained MR or CR after nCRT. All pts underwent RT on total mesorectum and draining lymph nodes at 45 Gy in 1.8 Gy/fraction, while the tumor and the corresponding mesorectum received 55Gy in 2.2Gy/fraction, with a Simultaneous Integrated Boost technique. Concomitant chemotherapy (CT) included chronomodulated orally capecitabine or CAPOX schedule, depending on clinical stage.

All pts underwent restaging at least at 6-8 weeks with digital rectal exploration (DRE), magnetic resonance imaging (MRI); rectoscopy was not mandatory.

Surgery, if needed, was planned at least 10-12 weeks from the end of nCRT.

In selected case of MR or CR an organ preservation approach was performed by LE or wait and see (W&S). In this selected cases a close FUP was performed with  DRE and rectoscopy every 3 months and MRI every 6 months, for 2 years. In case of tumoral regrowth TME surgery was suggested.

Results

From January 2014 to December 2017, 61 LARC pts achieved a MR or CR at first restaging (Table 1).

Only 15 (24.6%) pts underwent a second restaging at 12th – 14th weeks which confirmed a MR, CR  and partial response in 12, 2 and 1 cases, respectively.

Seventeen (27.9%) pts achieved a MR: 13 and 4 underwent TME and LE, respectively. Among these one patient with a ypT2 after TEM refused major surgery. All pts are alive without disease. 

 44 (72.3%) pts achieved a CR: 22 underwent conservative approach (9 TEM and 13 W&S) and 22 ones TME surgery.  Within 3 years from diagnosis, 4 (9.09%) pts who underwent conservative approach presented local recurrence and therefore underwent LE and 4 (9.09%) developed distant metastases (mainly hepatic). All pts are alive with stable disease.

Overall, pts underwent surgery obtained a pCR, ypT2-3 and ypN+ in 8, 11 and 3 cases, respectively. All patients are alive without disease, except for one patient who died of senescence.

Among the patients who underwent surgical treatment, 23 (47%) of them obtained a correspondence between ycT and ypT . Table 2 reported correlation between clinical and pathological response.




Tab 1
Conclusion

This results supported a conservative approach in a subset of LARC pts who achieve MR or CR after nCRT. A standardized restaging with DRE, MRI and rectoscopy could increase the prediction of cCR. Furthermore a close FUP is needed because of the major risk of local recurrence and distance metastases.