P-338 - Non-Operative Treatment after Neo-Adjuvant Short Course Radiotherapy (The Tlalpan Regime) in a combined modality for Locally Advanced Rectal Cancer...

Date 04 July 2015
Event WorldGI 2015
Session Posters
Topics Rectal Cancer
Surgery and/or Radiotherapy of Cancer
Presenter J. Zamora Moreno
Citation Annals of Oncology (2015) 26 (suppl_4): 1-100. 10.1093/annonc/mdv233
Authors J. Zamora Moreno1, G. Santiago Concha2, E. Mitsoura3, E. Ruiz Garcia4, V. Aiello Crocifoglio5
  • 1Instituto Nacional de Cancerología México, México City/MX
  • 2Instituto Nacional de Cancerología México, México/MX
  • 3Universidad Autonoma del Estado de Mexico, Toluca/MX
  • 4Instituto Nacional de Cancerologia, Tlalpan/MX
  • 5Instituto Nacional de Cancerologia Mexico, Mexico/MX

Abstract

Introduction

We previously described (Barcelona 2014), the pathologic complete response (pCR), after neo-adjuvant chemoradiotherapy (nACRT) in locally advanced rectal carcinoma, T3 or node-positive disease (LARC) with risk factors (low rectum tumors, higher clinical stages and serum CEA elevated). Here we report long-term results of non-surgical treatment in patients who rejected surgery after nACRT.

Methods

From January 2005 to December 2009, patients with locally advanced rectal cancer were treated with preoperative concurrent chemoradiotherapy, consisting of 4500 cGy delivered in fractions of 300 cGy per day, five days per week, in 3 weeks and fluoro-uracil, 29 patients (53.7%) or capecitabine 23 patients (42.6%), 1 patient folfox regime (1.9%) concurrently and 1 patient (1.9%) without ct.

Results

We identified 99 patients receiving the neo-adjuvant approach, after 8 weeks of rest and a control endoscopy, with negative biopsy, 54 patients (54.54%) accepted the surgery proposed with a final pCR in 18 patients (33.33%), and 45 patients in a well being status rejected the surgical treatment, we analyzed the patients who accepted the follow-up as proposed, with a total number of 14 patients (31.11%) the median age was 57.57 years (range 22-83), gender 6 female (42.9%) and 8 male (57.1%), tumor size 7.07 cm (range 4-14 cm), distance from anal verge 2.5 cm (range 0-5 cm), clinical stage according to AJCC 2002 were CS II, 4 patients (28.6%), CS III, 8 patients (57.1%), CS IV, 2 patients (14.3%). The median CEA for the patients was 38.84 ng/ML (1-334). The cCR (endoscopy + biopsy + computed tomography) was reached in 10 patients (71.42%), cPR in 3 patients (21.4%) and NS in 1 patient (7.1%). No toxicity grades III or IV was noted, with a median follow-up of 54.10 months (range 27.73-84.93), the median OS is not reached, and at 5 years, 85.7% of this patients are alive and colostomy free, with the first patient deceased at 27.7 months.

Conclusion

As a retrospective study, it has several limitations. However, based in our clinical data, this non-conventional treatment using a short course of radiotherapy in a neo-adjuvant approach for LARC, after obtaining some good responses, suggests a favorable outcome in some patients. Further studies are necessary to identify these patients who could benefit from this approach, avoiding a devastating surgery.