Low regrowth after cCR in non-operative TNT management of locally advanced rectal cancer patients
PO-1316
Abstract
Low regrowth after cCR in non-operative TNT management of locally advanced rectal cancer patients
Authors: Ugur Selek1, Fatih Selçukbiricik2, Emre Ozoran3, Emre Balik3, Yasemin Bolukbasi4, Nil Molinas Mandel2, Dursun Bugra3
1Koç University, School of Medicine , Department of Radiation Oncology , Istanbul, Turkey; 2Koç University, School of Medicine, Department of Medical Oncology, Istanbul, Turkey; 3Koç University, School of Medicine, Department of General Surgery, Istanbul, Turkey; 4Koç University, School of Medicine, Department of Radiation Oncology, Istanbul, Turkey
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Purpose or Objective
The non-operative management (NOM) approach in the treatment of locally advanced rectal cancer provides avoidance of possible early and long-term morbidity, mortality, and organ loss of surgery in patients with complete clinical response (cCR) after total neoadjuvant therapy (TNT). Our aim is to evaluate the survival and local or systemic recurrence in patients with locally advanced rectal cancer considered cCR after TNT and followed up with NOM.
Material and Methods
Patients diagnosed with locally advanced rectal cancer who applied to Vehbi Koç Foundation Health Institutions were evaluated with magnetic resonance imaging, FDG-Positron emission tomography with computed tomography, and endoscopy after TNT. The patients that had cCR according to imaging and endoscopic response were followed up with NOM, and survival, local or systemic recurrence was assessed in this subgroup of patients.
Results
Between 2014 and 2021, 201 out of 270 locally advanced rectal cancer (T3N+) patients in VKV Health institutions who met the criteria were recruited to the TNT approach. Among these patients, 53 (26%) with cCR were included in the NOM protocol. During the median 33-month median follow-up, regrowth was observed in 2 (3%) of the patients who underwent NOM, and these patients had salvage surgery. Surgery could not be performed in one patient because of distant metastasis, and he received systemic therapy again. There was no survival difference in patients with partial complete response and cCR who did not accept NOM and underwent total mesorectal excision compared to the patients who were followed up with the NOM approach.
Conclusion
NOM, especially in selected patients after total neoadjuvant therapy, is a promising approach where sphincter and rectal functions may be preserved, allowing salvage surgery in local recurrences that can be applied with close follow-up and patient compliance and will change our practice.
NOM is a promising approach where sphincter and rectal functions may be preserved, allowing salvage surgery in local recurrences, especially in selected cases after total neoadjuvant therapy. It can be applied by providing close follow-up as well as patient compliance and will change our practice.