ORGAN PRESERVATION AFTER TOTAL NEOADJUVANT THERAPY FOR DISTAL RECTAL CANCER TREATED IN THE COMMUNITY

Introduction Total Neoadjuvant Therapy (TNT) is a standard treatment for locally advanced distal rectal cancer (LADRC), especially for candidates for an organ preservation strategy.

Objective To evaluate the overall organ preservation (OP) after TNT regimens in a population with LADRC treated in the community.

Method We performed a real-world retrospective cohort study in two health institutions between May 2020 to June 2023. We included data from medical records of all consecutive patients (pts) with LADRC treated with TNT. We only selected pts with clinical primary tumor stage 3-4 and/or regional lymph node–positive whose distance from the anal verge ≤ 6cm on magnetic resonance imaging (MRI) before start TNT. All pts were restaging with digital rectal examination, rectal MRI and endoscopy after TNT. The primary endpoint was Total Mesorectal Excision (TME) free survival after completion of TNT. The secondary endpoints were rate of abdominoperineal resection surgery and rate of sphincter-preserving surgery after completion of TNT.

Results A total of 16 pts were included. Median age was 59 years (range: 33-77) and 8 (50%) were male. According to 8th AJCC, 11 pts (69%) were stage III, 13 pts (81%) were cT3, and 11 pts (69%) were cN1-2. Median tumor distance from anal verge was 4.1cm (range: 0.8-6.0). All pts were treated with long-course concurrent chemoradiotherapy followed by consolidation chemotherapy. At the time of this report, 12 pts have completed treatment with TNT and have undergone primary and secondary efficacy analyses. Median time from treatment initiation was 19.6 months (range: 7.0-37.7). Median time from completion of chemoradiation to restaging was 6.2 months (range: 5.0-10.8). Overall TME-free survival after completion of TNT was 50% [95% Confidence Interval (CI): 25-75]. Overall rate of abdominoperineal resection surgery and sphincter-preserving surgery were 33% (95% CI: 14-61) and 17% (95% CI: 5-45), respectively.

Conclusion Preliminary data suggest that half of patients with LADRC treated in the community can potentially achieve OP after TNT.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025