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Poster display session

2018 - Planned organ preservation for selected T2, T3 rectal cancer. French experience using chemo radiotherapy and Contact X Ray boost

Date

09 Sep 2017

Session

Poster display session

Topics

Surgical Oncology;  Radiation Oncology;  Colon and Rectal Cancer

Presenters

Jean-Pierre Gérard

Citation

Annals of Oncology (2017) 28 (suppl_5): v158-v208. 10.1093/annonc/mdx393

Authors

J. Gérard1, N. Barbet2, K. Benezery Sanna3, R. Coquard4, Y. Chateau5, J. Gal5, J. Doyen3

Author affiliations

  • 1 Radiothérapie, Centre Anticancer Antoine Lacassagne, 06189 - Nice/FR
  • 2 Radiothérapie, Centre de Radiothérapie, Macon/FR
  • 3 Radiothérapie, Centre Antoine Lacassagne, 06189 - Nice/FR
  • 4 Radiothérapie, Centre Bayard, 69000 - Lyon Villeurbanne/FR
  • 5 Research Department, Centre Antoine Lacassagne, 06189 - Nice/FR
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Resources

Abstract 2018

Background

Combining CRT (50 Gy+ capecitabine) and CXB boost provides high probability of organ preservation. We report the experience of three French institutions using CXB.

Methods

Selection used digital rectal examination, colonoscopy, MRI (and/or Endorectal-ultrasound, 18FDG Pet-CT). Inclusion was: adenocarcinoma (distal, middle rectum), T2 T3a-b, tumor diameter ≤ 4cm, N0, M0. Treatment: CXB (80-110 Gy/3-4 fr) followed by CRT (CAP 50). Tumor response assessed on week 14 after start of treatment using DRE, rigid rectoscopy and MRI. Clinical complete response (cCR) was defined as no visible tumor, supple rectal wall and TRG 1-2 MRI. In case of cCR a close surveillance or local excision was proposed.

Results

Between 2002 -2016, 84 patients were treated (Lyonvilleurbanne: 16, Mâcon: 11, Nice: 57). Median age: 75 years, Male: 59, Female: 25. T2:52; T3:32. Operable patients: 69 (83%). Median follow-up time was 53 months. A cCR was achieved in 94% of cases. Local excision was performed in 16 patients (ypT0/pT1: 14). At 4 years, the cancer specific survival was 82% [CI:96-70] and the local relapse rate 12% [CI: 2-22]. 7 local relapses were seen with 2 after 5 years with one isolated perirectal lymph node relapse at 7 years. Acute grade 3 toxicity (diarrhea, proctitis) was seen in 9 patients mainly related to CRT and did not require treatment modification. Main late toxicity (> 6 months after treatment) was rectal bleeding (due to radiation telangiectasia) which required plasma argon coagulation in 5 patients. No TME surgery was performed and organ preservation was achieved in all cases (75 patients with local control). Bowel function was good (LARS score

Conclusions

After adequate selection and treatment, rectal cancer T2T3a-b N0 ≤4cm can achieve a high rate of cCR (≥85%) with organ preservation, good bowel function and low rate of local relapse (< 15%) with low toxicity. Prolonged follow-up is mandatory. As rectal adenocarcinoma is radioresistant tumor, the treatment must combine CRT and CXB boost. Like anal squamous cell cancer, planned organ preservation can be proposed to operable patients. The ongoing European OPERA trial aims at bringing evidence to this option.

Clinical trial identification

OPERA Protocol number: 2014-A01851-46

Legal entity responsible for the study

Centre Antoine Lacassagne, Nice, France

Funding

None

Disclosure

J-P. Gérard: Medical advisor of Ariane Medical system company Derbi, UK All other authors have declared no conflicts of interest.

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