@article{0778ef8fb17b41d0a9e07e3584138e3f,
title = "Status for clinically complete remission rectal cancer after concomitant chemo-radiotherapy in Taiwan",
abstract = "Treatment for Rectal cancer changed after the induction of concomitant chemo-radiotherapy, CCRT. Complete remission of the tumor leads to debate of the necessity of surgical intervention. We evaluate the treatment outcome to know if operation is beneficial to these patients. Patients received long course concomitant chemo-radiotherapy for advanced rectal cancer between 2004 and 2013 in Taiwan were enrolled. Total 2780 patients diagnosed advanced rectal cancer were enrolled. In these patients, 2578 received surgical intervention and 202 were in wait and see for complete remission tumor. Higher local recurrence rate was found with wait and see group (8.9% vs. 2.7%). Also, better overall survival, disease free survival and local recurrence free survival were seen with the surgical intervention group. Surgical intervention may be benefit for some misdiagnosed completed response to CCRT.",
keywords = "Complete remission, Long course CCRT, Rectal cancer, Watch and wait",
author = "Lin, {Geng Ping} and Lee, {Kuan Der} and Wang, {Jeng Yi} and Chen, {Jinn Shiun} and Chiang, {Chun Ju} and Yeh, {Chien Yuh}",
note = "Funding Information: We traced the data from the Health Promotion Administration, Ministry of Health and Welfare, Taiwan. Patients diagnosed with rectal cancer (within 15 cm from anal verge) and who received neoadjuvant CCRT between 2004 and 2013 were recruited. Pre-treatment diagnostic tools included complete colonoscopy to rule out synchronous colorectal lesion, and MRI or computed tomography (CT) to determine the presence of possible nodal metastasis or distant metastasis. Tissue was obtained during colonoscopy for pathological diagnosis and to confirm the necessity of neoadjuvant therapy. Neuroendocrine tumors, gastrointestinal stromal tumors or other radiotherapy insensitive tumors were excluded. The neoadjuvant therapy was long course radiotherapy (5040 cGy–5400 cGy) with 5-Fu based chemotherapy. After CCRT, repeat exams were arranged and the post-CCRT changes were recorded. Patients were excluded if they were lost to follow up, or if distant metastases were found during CCRT. The remaining patients were divided into two groups, depending on whether they had surgical intervention or not. The available diagnostic tools for the clinical complete response patients included anal digital exam, image study (CT. MRI, or PET), or colonoscopy exam with/without tissue biopsy. The decision for resection or not was based on the clinical findings. Regarding the surgical group, operations were performed 6–8 weeks after the completion of radiotherapy. Tumor size, grade, stage and regression status were recorded by pathologists. Both groups received similar program of follow-up assessment. During follow-up, digital examination, chest radiography, carcinoembryonic antigen (CEA) level determination, CT, PET, abdominal ultrasonography, and colonoscopy were performed to evaluate metastatic or recurrent disease. Recurrence was defined in three categories as local recurrence, regional recurrence, and distant metastasis. Local recurrence means a new tumor lesion was found at an anastomotic site or local excision site for the surgery group and previous tumor location for the non-surgical group. Regional recurrence was diagnosed by studying images including CT/MRI/PET. Tumor or mass lesion was identified within the pelvic area but not linked to previous tumor or anastomotic site were assigned in this category. Distant metastasis was also diagnosed by studying images. Data were analyzed using SPSS software (version 20, IBM). Comparisons between groups were made using Fisher's exact test. Survival differences were compared using the log-rank test. Statistical significance was set at P < 0.05. This work was supported by Health Promotion Administration, Ministry of Health and Welfare, Taiwan (R.O.C.) ( A1041015 ). Funding was obtained from the Tobacco Control and Health Care funds. 3 ",
year = "2018",
month = may,
doi = "10.1016/j.asjsur.2017.07.002",
language = "English",
volume = "41",
pages = "203--209",
journal = "Asian Journal of Surgery",
issn = "1015-9584",
publisher = "Elsevier Taiwan LLC",
number = "3",
}
