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The timing of surgery after preoperative short-course S-1 chemoradiotherapy with delayed surgery for T3 lower rectal cancer

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to analyze the influence of variations in clinical practice regarding the timing of surgery with short-course chemoradiotherapy with delayed surgery (SCRT-delay) for lower rectal cancer.

Methods

A total of 171 patients with T3 N0-2 lower rectal cancer treated with SCRT-delay (25 Gy/10 fractions/5 days (S-1); days 1–10) were retrospectively evaluated. The median waiting period of 30 days was used as a discriminator (group A: waiting period, ≤30 days; group B: waiting period, ≥31 days). Preoperative treatment responses and oncological outcomes were analyzed.

Results

The mean waiting periods for groups A and B were 24.4 ± 5.3 and 41.4 ± 12.3 days, respectively. There were no statistically significant differences between the two groups in any of the clinical variables. The clinicopathological outcomes were as follows: T downstaging (43.5 vs 37.2 %; p = 0.400), negative yp N (67.1 vs 75.6 %; p = 0.218), pCR (7.1 vs 1.2 %; p = 0.119). The 5-year local recurrence-free survival (89.3 vs 87.6 %; p = 0.956), the recurrence-free survival (82.2 vs 78.8 %; p = 0.662), and the overall survival (88.5 vs 84.4 %; p = 0.741), all of which were similar between the two groups.

Conclusions

The longer waiting period did not increase the tumor downstaging and not improve the oncological outcomes for T3 lower rectal cancer treated with SCRT-delay. In addition, considering that the impaired leukocyte response occurred during the sub-acute period, any time after the sub-acute period (day 12) up to 30 days after radiotherapy would be a suitable waiting period.

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Acknowledgments

The authors are grateful to Professors Hirota, Nishigami, and Terada, Department of Pathology, Hyogo College of Medicine and Dr Kakuno, Department of Pathology, Meiwa Hospital who performed the pathological assessment.

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Authors and Affiliations

  1. Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan

    Naohito Beppu, Nagahide Matsubara, Masashi Noda, Tomoki Yamano & Naohiro Tomita

  2. Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan

    Hiroshi Doi & Norihiko Kamikonya

  3. Department of Surgery, Meiwa Hospital, 4-31 Agenaruo-chho, Nishinomiya, Hyogo, 663-8186, Japan

    Naoki Yamanaka & Hidenori Yanagi

Authors
  1. Naohito Beppu
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  2. Nagahide Matsubara
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  3. Masashi Noda
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  4. Tomoki Yamano
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  7. Naoki Yamanaka
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  8. Hidenori Yanagi
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  9. Naohiro Tomita
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Corresponding author

Correspondence to Naohito Beppu.

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Beppu, N., Matsubara, N., Noda, M. et al. The timing of surgery after preoperative short-course S-1 chemoradiotherapy with delayed surgery for T3 lower rectal cancer. Int J Colorectal Dis 29, 1459–1466 (2014). https://doi.org/10.1007/s00384-014-1997-5

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  • DOI: https://doi.org/10.1007/s00384-014-1997-5

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