Does the interval to surgery following chemoradiation for rectal cancer affect outcome?: F06

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Aim:The optimal time for surgery after neoadjuvant chemoradiation (CR) is controversial.The effect of the time interval between CR and surgery on the result of treatment was assessed.Method:From 2006, 108 pts with T2-4 N0-2 M0 rectal carcinoma were enrolled in the study. CR was given concurrently with 5-FU 350 mg/m2 and cisplatin 90 mg up to a total dose of 47 Gy. Surgery was performed after 21-40 days (group 1) and after 41-72 days (group 2) after CR.Results:The distance of the ‘lower border of the tumour from the anal verge (5.1 ± 2.2 and 5 ± 2.3 cm) and theproportion of sphincter savingprocedure (SSP) (72.7% and 71.7%) were similar in both groups. There was a greater degree of tumour downstaging (pT0-2) in group 2 (52.8%) compared with group 1 (32.6%), P = 0.02. The tumour regression grade (grades 1-2) 39.6% and 29.1%, accordingly. At a median follow-up of 17 months there were 18.1% distant metastases (in 3.6% cases with local recurrence) in group 1 and 1.9% in group 2 (P = 0.008). Disease Free Survival (DFS) was 67.9% and 97.4% in groups 1 and 2 (P = 0.007). Overall survival (OS) was also better in group 2 (100%) comparing with group 1 (82.9%) (P = 0.02).Conclusion:Delaying surgery after CR did not increase the rate of SSP but it wasassociated with tumour downstaging and improved long term results.

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