Scholars@Duke publication: Long-term Clinical Outcomes of Nonoperative Management With Chemoradiotherapy for Locally Advanced Rectal Cancer in the Veterans Health Administration.

Long-term Clinical Outcomes of Nonoperative Management With Chemoradiotherapy for Locally Advanced Rectal Cancer in the Veterans Health Administration.

Publication , Journal Article

Spiegel, DY; Boyer, MJ; Hong, JC; Williams, CD; Kelley, MJ; Moore, H; Salama, JK; Palta, M

Published in: Int J Radiat Oncol Biol Phys

March 1, 2019

PURPOSE: Standard therapy for locally advanced rectal cancer includes neoadjuvant chemoradiation and surgery. Complete response (CR) rates after chemoradiation can be as high as 29%, suggesting that nonoperative management (NOM) may be reasonable with appropriately selected patients. We sought to identify potential NOM candidates. METHODS AND MATERIALS: Using the Veterans Administration Central Cancer Registry, patients with stage II to III rectal cancer receiving chemoradiation with or without subsequent surgery were identified. Clinical CR (cCR) was assessed by physical examination, endoscopy, or imaging. Kaplan-Meier and log-rank tests were used to assess survival; multivariate analysis was performed using Cox proportional hazards. RESULTS: A total of 1313 patients were identified. Of these, 313 received chemoradiation alone (CRT cohort); 1000 received chemoradiation followed by surgery (CRT + S cohort). Median follow-up was 67.2 months. Median overall survival (OS) was 68.5 months. Median OS was 30.6 months for CRT and 89.3 months for CRT + S (P < .001). Median disease-specific survival (DSS) was 44.8 months for CRT and not reached (NR) for CRT + S (P < .001). Sixty-five CRT patients (20.8%) had a cCR. Median OS for CRT cCR patients was 73.5 months (P = .128 vs CRT + S); median DSS was NR (P = .161 vs CRT + S). One hundred thirty-seven (10.5%) CRT + S patients had a pathologic CR (pCR). Median OS with pCR was 133.7 months (P < .001 vs CRT cCR), and median DSS was NR (P = .276 vs CRT cCR). CONCLUSIONS: CRT patients with cCR had similar OS and DSS versus CRT + S patients and similar DSS versus CRT + S patients with a pCR. This suggests that patients with locally advanced rectal cancer with a cCR to CRT have an excellent prognosis and may be candidates for organ preservation.

Duke Scholars

Author Matthew Jacob Boyer Radiation Oncology

Author Christina D Williams Medicine, Medical Oncology

Author Michael John Kelley Medicine, Medical Oncology

Author Harvey Gorden Moore III Surgical Oncology

Author Joseph Kamel Salama Radiation Oncology

Author Manisha Palta Radiation Oncology

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Published In

Int J Radiat Oncol Biol Phys

DOI

10.1016/j.ijrobp.2018.10.018

EISSN

1879-355X

Publication Date

March 1, 2019

Volume

103

Issue

Start / End Page

565 / 573

Location

United States

Related Subject Headings

Veterans Health
United States Department of Veterans Affairs
United States
Treatment Outcome
Registries
Rectum
Rectal Neoplasms
Proportional Hazards Models
Oncology & Carcinogenesis
Neoadjuvant Therapy

Citation

APA

Chicago

ICMJE

MLA

NLM

Spiegel, D. Y., Boyer, M. J., Hong, J. C., Williams, C. D., Kelley, M. J., Moore, H., … Palta, M. (2019). Long-term Clinical Outcomes of Nonoperative Management With Chemoradiotherapy for Locally Advanced Rectal Cancer in the Veterans Health Administration. Int J Radiat Oncol Biol Phys, 103(3), 565–573. https://doi.org/10.1016/j.ijrobp.2018.10.018

Spiegel, Daphna Y., Matthew J. Boyer, Julian C. Hong, Christina D. Williams, Michael J. Kelley, Harvey Moore, Joseph K. Salama, and Manisha Palta. “Long-term Clinical Outcomes of Nonoperative Management With Chemoradiotherapy for Locally Advanced Rectal Cancer in the Veterans Health Administration.” Int J Radiat Oncol Biol Phys 103, no. 3 (March 1, 2019): 565–73. https://doi.org/10.1016/j.ijrobp.2018.10.018.

Spiegel DY, Boyer MJ, Hong JC, Williams CD, Kelley MJ, Moore H, et al. Long-term Clinical Outcomes of Nonoperative Management With Chemoradiotherapy for Locally Advanced Rectal Cancer in the Veterans Health Administration. Int J Radiat Oncol Biol Phys. 2019 Mar 1;103(3):565–73.

Spiegel, Daphna Y., et al. “Long-term Clinical Outcomes of Nonoperative Management With Chemoradiotherapy for Locally Advanced Rectal Cancer in the Veterans Health Administration.” Int J Radiat Oncol Biol Phys, vol. 103, no. 3, Mar. 2019, pp. 565–73. Pubmed, doi:10.1016/j.ijrobp.2018.10.018.

Spiegel DY, Boyer MJ, Hong JC, Williams CD, Kelley MJ, Moore H, Salama JK, Palta M. Long-term Clinical Outcomes of Nonoperative Management With Chemoradiotherapy for Locally Advanced Rectal Cancer in the Veterans Health Administration. Int J Radiat Oncol Biol Phys. 2019 Mar 1;103(3):565–573.