Neoadjuvant Therapy for Rectal Cancer: The Impact of Longer Interval Between Chemoradiation and Surgery

Abstract

An interval between chemoradiation and surgery ≥ 8 weeks is safe and is associated with a higher rate of pathologic complete response and decreased local recurrence.

Waiting Time following Neoadjuvant Chemoradiotherapy for Rectal Cancer: Does It Really Matter

“…Even though CRT has improved the outcome of rectal cancer, the optimal timing of surgical resection after CRT remains uncertain. De Campos-Lobato et al [1] showed that waiting for more than 8 weeks between completion of CRT and surgery was associated with significant improvement in pathological complete response (pCR) rate (30.8 vs. 16.5%, p = 0.03) and decreased the 3-year local recurrence rate (1.2 vs. 10.5%, p = 0.04). Other studies have indicated downstaging and better surgical outcomes with a delay of more than 8 weeks [11,12].…”

“…Neoadjuvant chemoradiotherapy (CRT) is considered the standard approach before any surgical intervention for locally advanced rectal tumors [1]. Total mesorectal excision combined with neoadjuvant CRT has resulted in significant improvement of local disease control, lower rates of local recurrence, more effective tumor downstaging, and greater success rates in sphincter-sparing surgery [2][3][4].…”

“…The group with the longer waiting period had better tumor response, pathological downstaging, and higher sphincter-sparing surgery rates. However, there has been concern that such delays would make the operation more challenging due to technical difficulties, including fibrosis, and may result in increased morbidity or even locoregional recurrence [1,6]. Many surgeons remain reluctant to delay surgical intervention beyond 2 months.…”

The D Prefix

“…Following completion of CRT, both individual series , population studies and a metaanalysis 3 all show that longer intervals up to a maximum of 12 -15 weeks appear associated with an increased chance of achieving a pCR at surgical resection, and counter-intuitively outcomes may also improve in terms of a significant reduction in 3-year local recurrence rate (1.2% vs. 10.5%, p = 0.04). 4 However, further extensions of this interval do not appear to benefit the patient. 5,6 Patients with rectal cancer, who achieve a pCR or near pCR, fare consistently better than the patients who fail to do so.…”

Response to Letter to the Editor: Neoadjuvant Therapy for Rectal Cancer: The Impact of Longer Interval Between Chemoradiation and Surgery

“…1 He brings forth several key issues that remain among the top challenges in treating rectal cancer. We agree that it would obviously be paramount to identify which patients would achieve a pathologic complete response (pCR), but unfortunately this is not currently possible.…”