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No Long-Term Advantage for Complete Response to Neoadjuvant Chemo/RT

No Long-Term Advantage for Complete Response to Neoadjuvant Chemo/RT

WASHINGTON—Stage II and III rectal cancer patients who achieve a
complete response (CR) to neoadjuvant chemoradiation do not enjoy any long-term
survival advantage over patients who do not, Mark Onaitis, MD, of Duke
University Medical Center, said at the 54th Annual Cancer Symposium of the
Society of Surgical Oncology.

Neoadjuvant chemoradiation for rectal cancer has been observed to cause
clinical downstaging, he said. Whether response affects survival and whether
downstaging makes responders candidates for later local excision have been
unclear, however. The present study of complete responders aimed to explore
these questions.

A database of 131 rectal cancer patients who had received fluorouracil
(5-FU)-based chemotherapy plus radiation therapy (45 Gy) yielded 30 complete
T-stage responders, according to pathologic analysis performed postoperatively.

Begun in 1987, the database also provided information on patient demography,
pre- and postoperative tumor staging, the type of surgery performed, number and
nature of complications, and survival. Complete responders resembled the other
100 patients in their tumor characteristics before surgery.

Neoadjuvant chemoradiation "made no long-term difference in terms of
local recurrence and survival rates," Dr. Onaitis said. Although the
complete responders enjoyed an "early survival advantage," this did
not persist in the long term, he reported.

Complete pathologic tumor sterilization, therefore, "confers no
long-term advantage," he observed, noting that clinical response proved
unreliable as a predictor of long-term survival.

Only lymph node status proved a significant prognostic factor in this study,
he said. He noted that 4 of the complete T-stage responders had positive lymph
nodes. "This is also part of the rationale for recommending against local
excision (in which no lymph nodes are resected)," he said.

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