Avoidance of Overtreatment of Rectal Cancer by Selective Chemoradiotherapy: Results of the Optimized Surgery and MRI-Based Multimodal Therapy Trial.

Journal of the American College of Surgeons
Reinhard Ruppertother members of the OCUM Group

Abstract

Neoadjuvant chemoradiotherapy (nCRT) in patients with rectal cancer carries a high risk of adverse effects. The aim of this study was to examine the selective application of nCRT based on patient risk profile, as determined by MRI, to find the optimal range between undertreatment and overtreatment. In this prospective multicenter observational study, nCRT before total mesorectal excision (TME) was indicated in high-risk patients with involved or threatened mesorectal fascia (≤1 mm), or cT4 or cT3 carcinomas of the lower rectal third. All other patients received primary surgery. Of the 1,093 patients, 878 (80.3%) were treated according to the protocol, 526 patients (59.9%) underwent primary surgery, and 352 patients (40.1%) underwent nCRT followed by surgery. The 3-year locoregional recurrence (LR) rate was 3.1%. Of 604 patients with clinical stages II and III, 267 (44.2%) had primary surgery; 337 (55.8%) received nCRT followed by TME. The 3-year LR rate was 3.9%, without significant differences between groups. In patients with clinical stages II and III who underwent primary surgery, 27.3% were diagnosed with pathological stage I. The results justify the restriction of nCRT to high-risk patients with rectal cancer classified by...Continue Reading

Associated Clinical Trials

Citations

Apr 21, 2021·Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen·Sigmar StelznerSören Torge Mees
Apr 25, 2021·Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen·Johannes Christian LauscherMartin E Kreis
Apr 29, 2021·Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen·Sigmar StelznerJohannes Wessling
Jul 18, 2021·International Journal of Radiation Oncology, Biology, Physics·Christopher J AnkerJeffrey R Olsen
May 6, 2021·AJR. American Journal of Roentgenology·Harmeet KaurGeorge Chang

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