Long-term oncologic outcome following preoperative combined modality therapy and total mesorectal excision of locally advanced rectal cancer

Jose G. Guillem, David B. Chessin, Alfred M. Cohen, Jinru Shia, Madhu Mazumdar, Warren Enker, Philip B. Paty, Martin R. Weiser, David Klimstra, Leonard Saltz, Bruce D. Minsky, W. Douglas Wong, Kirby I. Bland, William G. Cance, Edward M. Copeland, Frederick L. Greene, Courtney Townsend, Nipun Merchant, Alfred M. Cohen

Research output: Contribution to journalArticle

299 Citations (Scopus)

Abstract

Objective: Our aims were to (1) determine the long-term oncologic outcome for patients with rectal cancer treated with preoperative combined modality therapy (CMT) followed by total mesorectal excision (TME), (2) identify factors predictive of oncologic outcome, and (3) determine the oncologic significance of the extent of pathologic tumor response. Summary Background Data: Locally advanced (T3-4 and/or N1) rectal adenocarcinoma is commonly treated with preoperative CMT and TME. However, the long-term oncologic results of this approach and factors predictive of a durable outcome remain largely unknown. Methods: Two hundred ninety-seven consecutive patients with locally advanced rectal adenocarcinoma at a median distance of 6 cm from the anal verge (range 0-15 cm) were treated with preoperative CMT (radiation: 5040 centi-Gray (cGy) and 5-fluorouracil (5-FU)-based chemotherapy) followed by TME from 1988 to 2002. A prospectively collected database was queried for long-term oncologic outcome and predictive clinicopathologic factors. Results: With a median follow-up of 44 months, the estimated 10-year overall survival (OS) was 58% and 10 year recurrence-free survival (RFS) was 62%. On multivariate analysis, pathologic response >95%, lymphovascular invasion and/or perineural invasion (PNI), and positive lymph nodes were significantly associated with OS and RFS. Patients with a >95% pathologic response had a significantly improved OS (P = 0.003) and RFS (P = 0.002). Conclusions: Treatment of locally advanced rectal cancer with preoperative CMT followed by TME can provide for a durable 10-year OS of 58% and RFS of 62%. Patients who achieve a >95% response to preoperative CMT have an improved long-term oncologic outcome, a novel finding that deserves further study.

Original languageEnglish (US)
Pages (from-to)829-838
Number of pages10
JournalAnnals of Surgery
Volume241
Issue number5
DOIs
StatePublished - May 2005
Externally publishedYes

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Combined Modality Therapy
Rectal Neoplasms
Survival
Recurrence
Adenocarcinoma
Fluorouracil
Multivariate Analysis
Lymph Nodes
Databases
Radiation
Drug Therapy

ASJC Scopus subject areas

  • Surgery

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Long-term oncologic outcome following preoperative combined modality therapy and total mesorectal excision of locally advanced rectal cancer. / Guillem, Jose G.; Chessin, David B.; Cohen, Alfred M.; Shia, Jinru; Mazumdar, Madhu; Enker, Warren; Paty, Philip B.; Weiser, Martin R.; Klimstra, David; Saltz, Leonard; Minsky, Bruce D.; Wong, W. Douglas; Bland, Kirby I.; Cance, William G.; Copeland, Edward M.; Greene, Frederick L.; Townsend, Courtney; Merchant, Nipun; Cohen, Alfred M.

In: Annals of Surgery, Vol. 241, No. 5, 05.2005, p. 829-838.

Research output: Contribution to journalArticle

Guillem, JG, Chessin, DB, Cohen, AM, Shia, J, Mazumdar, M, Enker, W, Paty, PB, Weiser, MR, Klimstra, D, Saltz, L, Minsky, BD, Wong, WD, Bland, KI, Cance, WG, Copeland, EM, Greene, FL, Townsend, C, Merchant, N & Cohen, AM 2005, 'Long-term oncologic outcome following preoperative combined modality therapy and total mesorectal excision of locally advanced rectal cancer', Annals of Surgery, vol. 241, no. 5, pp. 829-838. https://doi.org/10.1097/01.sla.0000161980.46459.96
Guillem, Jose G. ; Chessin, David B. ; Cohen, Alfred M. ; Shia, Jinru ; Mazumdar, Madhu ; Enker, Warren ; Paty, Philip B. ; Weiser, Martin R. ; Klimstra, David ; Saltz, Leonard ; Minsky, Bruce D. ; Wong, W. Douglas ; Bland, Kirby I. ; Cance, William G. ; Copeland, Edward M. ; Greene, Frederick L. ; Townsend, Courtney ; Merchant, Nipun ; Cohen, Alfred M. / Long-term oncologic outcome following preoperative combined modality therapy and total mesorectal excision of locally advanced rectal cancer. In: Annals of Surgery. 2005 ; Vol. 241, No. 5. pp. 829-838.
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abstract = "Objective: Our aims were to (1) determine the long-term oncologic outcome for patients with rectal cancer treated with preoperative combined modality therapy (CMT) followed by total mesorectal excision (TME), (2) identify factors predictive of oncologic outcome, and (3) determine the oncologic significance of the extent of pathologic tumor response. Summary Background Data: Locally advanced (T3-4 and/or N1) rectal adenocarcinoma is commonly treated with preoperative CMT and TME. However, the long-term oncologic results of this approach and factors predictive of a durable outcome remain largely unknown. Methods: Two hundred ninety-seven consecutive patients with locally advanced rectal adenocarcinoma at a median distance of 6 cm from the anal verge (range 0-15 cm) were treated with preoperative CMT (radiation: 5040 centi-Gray (cGy) and 5-fluorouracil (5-FU)-based chemotherapy) followed by TME from 1988 to 2002. A prospectively collected database was queried for long-term oncologic outcome and predictive clinicopathologic factors. Results: With a median follow-up of 44 months, the estimated 10-year overall survival (OS) was 58{\%} and 10 year recurrence-free survival (RFS) was 62{\%}. On multivariate analysis, pathologic response >95{\%}, lymphovascular invasion and/or perineural invasion (PNI), and positive lymph nodes were significantly associated with OS and RFS. Patients with a >95{\%} pathologic response had a significantly improved OS (P = 0.003) and RFS (P = 0.002). Conclusions: Treatment of locally advanced rectal cancer with preoperative CMT followed by TME can provide for a durable 10-year OS of 58{\%} and RFS of 62{\%}. Patients who achieve a >95{\%} response to preoperative CMT have an improved long-term oncologic outcome, a novel finding that deserves further study.",
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T1 - Long-term oncologic outcome following preoperative combined modality therapy and total mesorectal excision of locally advanced rectal cancer

AU - Guillem, Jose G.

AU - Chessin, David B.

AU - Cohen, Alfred M.

AU - Shia, Jinru

AU - Mazumdar, Madhu

AU - Enker, Warren

AU - Paty, Philip B.

AU - Weiser, Martin R.

AU - Klimstra, David

AU - Saltz, Leonard

AU - Minsky, Bruce D.

AU - Wong, W. Douglas

AU - Bland, Kirby I.

AU - Cance, William G.

AU - Copeland, Edward M.

AU - Greene, Frederick L.

AU - Townsend, Courtney

AU - Merchant, Nipun

AU - Cohen, Alfred M.

PY - 2005/5

Y1 - 2005/5

N2 - Objective: Our aims were to (1) determine the long-term oncologic outcome for patients with rectal cancer treated with preoperative combined modality therapy (CMT) followed by total mesorectal excision (TME), (2) identify factors predictive of oncologic outcome, and (3) determine the oncologic significance of the extent of pathologic tumor response. Summary Background Data: Locally advanced (T3-4 and/or N1) rectal adenocarcinoma is commonly treated with preoperative CMT and TME. However, the long-term oncologic results of this approach and factors predictive of a durable outcome remain largely unknown. Methods: Two hundred ninety-seven consecutive patients with locally advanced rectal adenocarcinoma at a median distance of 6 cm from the anal verge (range 0-15 cm) were treated with preoperative CMT (radiation: 5040 centi-Gray (cGy) and 5-fluorouracil (5-FU)-based chemotherapy) followed by TME from 1988 to 2002. A prospectively collected database was queried for long-term oncologic outcome and predictive clinicopathologic factors. Results: With a median follow-up of 44 months, the estimated 10-year overall survival (OS) was 58% and 10 year recurrence-free survival (RFS) was 62%. On multivariate analysis, pathologic response >95%, lymphovascular invasion and/or perineural invasion (PNI), and positive lymph nodes were significantly associated with OS and RFS. Patients with a >95% pathologic response had a significantly improved OS (P = 0.003) and RFS (P = 0.002). Conclusions: Treatment of locally advanced rectal cancer with preoperative CMT followed by TME can provide for a durable 10-year OS of 58% and RFS of 62%. Patients who achieve a >95% response to preoperative CMT have an improved long-term oncologic outcome, a novel finding that deserves further study.

AB - Objective: Our aims were to (1) determine the long-term oncologic outcome for patients with rectal cancer treated with preoperative combined modality therapy (CMT) followed by total mesorectal excision (TME), (2) identify factors predictive of oncologic outcome, and (3) determine the oncologic significance of the extent of pathologic tumor response. Summary Background Data: Locally advanced (T3-4 and/or N1) rectal adenocarcinoma is commonly treated with preoperative CMT and TME. However, the long-term oncologic results of this approach and factors predictive of a durable outcome remain largely unknown. Methods: Two hundred ninety-seven consecutive patients with locally advanced rectal adenocarcinoma at a median distance of 6 cm from the anal verge (range 0-15 cm) were treated with preoperative CMT (radiation: 5040 centi-Gray (cGy) and 5-fluorouracil (5-FU)-based chemotherapy) followed by TME from 1988 to 2002. A prospectively collected database was queried for long-term oncologic outcome and predictive clinicopathologic factors. Results: With a median follow-up of 44 months, the estimated 10-year overall survival (OS) was 58% and 10 year recurrence-free survival (RFS) was 62%. On multivariate analysis, pathologic response >95%, lymphovascular invasion and/or perineural invasion (PNI), and positive lymph nodes were significantly associated with OS and RFS. Patients with a >95% pathologic response had a significantly improved OS (P = 0.003) and RFS (P = 0.002). Conclusions: Treatment of locally advanced rectal cancer with preoperative CMT followed by TME can provide for a durable 10-year OS of 58% and RFS of 62%. Patients who achieve a >95% response to preoperative CMT have an improved long-term oncologic outcome, a novel finding that deserves further study.

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