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Impact of Interval between Neoadjuvant Chemoradiotherapy and TME for Locally Advanced Rectal Cancer on Pathologic Response and Oncologic Outcome

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The interval between neoadjuvant chemoradiotherapy and surgery for rectal cancer has arbitrarily been set at 6–8 weeks. However, tumor regression is variable. This study aimed to evaluate whether the interval between neoadjuvant therapy and surgery had an impact on pathologic response and on surgical and oncologic outcome.

Methods

A total of 356 consecutive patients with clinical stage II and III rectal adenocarcinoma were identified. Median age was 63 years, and 65 % were men. All patients received neoadjuvant chemoradiotherapy (45 Gy) with a continuous infusion of 5-fluorouracil. Data on neoadjuvant-surgery interval, type of surgery, pathology, postoperative complications, length of hospital stay, disease recurrence, and survival were reviewed. Patients were divided into two groups according to the interval between neoadjuvant therapy and surgery: ≤7 weeks (short interval, n = 201) and >7 weeks (long interval, n = 155).

Results

The complete pathologic response rate was 21 %. It was significantly higher after a longer interval (28 %) than after a shorter interval (16 %, p = 0.006). A longer interval did not affect morbidity or length of hospital stay. After a median follow-up of 4.9 years, the 5-year cancer-specific survival rate was 83 % in the short-interval group versus 91 % in the long-interval group (p = 0.046), and the free-from-recurrence rate was 73 versus 83 %, respectively (p = 0.026).

Conclusions

In this retrospective analysis, there seems to be an association between a longer interval after neoadjuvant chemoradiotherapy and complete pathologic response without affecting postoperative morbidity and length of hospital stay, and with no detrimental effect on oncologic outcome.

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Conflict of Interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven, Belgium

    Albert M. Wolthuis MD, Freddy Penninckx MD, PhD & André D’Hoore MD, PhD

  2. Department of Radiation Oncology, University Hospital Gasthuisberg, Leuven, Belgium

    Karin Haustermans MD, PhD

  3. Department of Pathology, University Hospital Gasthuisberg, Leuven, Belgium

    Gert De Hertogh MD, PhD

  4. Interuniversity Centre for Biostatistics and Statistical Bioinformatics, Leuven, Belgium

    Steffen Fieuws PhD

  5. Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium

    Eric Van Cutsem MD, PhD

Authors
  1. Albert M. Wolthuis MD
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  2. Freddy Penninckx MD, PhD
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  3. Karin Haustermans MD, PhD
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  4. Gert De Hertogh MD, PhD
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  5. Steffen Fieuws PhD
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  6. Eric Van Cutsem MD, PhD
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  7. André D’Hoore MD, PhD
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Correspondence to Albert M. Wolthuis MD.

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Wolthuis, A.M., Penninckx, F., Haustermans, K. et al. Impact of Interval between Neoadjuvant Chemoradiotherapy and TME for Locally Advanced Rectal Cancer on Pathologic Response and Oncologic Outcome. Ann Surg Oncol 19, 2833–2841 (2012). https://doi.org/10.1245/s10434-012-2327-1

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  • DOI: https://doi.org/10.1245/s10434-012-2327-1

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