Preoperative neoadjuvant chemo-radiotherapy and complete pathological response in rectal cancer. What is the optimal interval to surgery?: P103

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Introduction:One-third of advanced low rectal cancers may have a complete clinical response following neoadjuvant chemo-radiotherapy (NACRT). As a result patients may avoid major and morbid surgery. Others argue that the complete pathological response (CPR) rate after NACRT is too low to recommend selective non operative management. However, time between NACRT and surgery varies between studies and increased time is associated with increased CPR rate.Aim:To audit time to surgery and tumour regression grade (TRG) after NACRT.Method:From 2004 to 2010 eighty eight patients with locally advanced rectal cancer received NACRT (45 Gy in 25 fractions over 5 weeks with either infusional or oral 5FU)prior to surgery. Time from NACRT to surgery was calculated and TRG assessedprospectively.Results:TRG1 (no residual cancer cells, n = 5), TRG2 (rare residual cancer cells with marked fibrosis, n = 23), TRG3 (marked fibrosis with scattered tumour cells, n = 29), TRG4 (abundant cancer cells with little fibrosis, n = 28), TRG5 (no regression, n = 3). Mean time to surgery was 7.8 weeks (18-116 days).Conclusion:Twenty-eight patients (32%) had only rare residual tumour cells or no tumour cells in their resection specimens at 7.8 weeks average after NACRT. Delaying surgery may improve TRG and justify a selective non operative policy.

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