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Outcomes of chemotherapy/chemoradiation vs. R2 surgical debulking vs. palliative care in nonresectable locally recurrent rectal cancer.
- Source :
-
Tumori [Tumori] 2024 Oct; Vol. 110 (5), pp. 360-365. Date of Electronic Publication: 2024 May 10. - Publication Year :
- 2024
-
Abstract
- Locally recurrent rectal cancer is resected with clear margins in only 50% of cases, and these patients achieve a three-year survival rate of 50%. Outcomes and therapeutic strategies for nonresectable locally recurrent rectal cancer have been much less explored. The aim of the study was to assess the three-year progression-free survival and the three-year overall survival in locally recurrent rectal cancer patients treated by chemotherapy/chemoradiation only vs. chemotherapy/chemoradiation and R2 surgical debulking vs. palliative care. A total of 86 patients affected by nonresectable locally recurrent rectal cancer were included: three-year progression-free survival was 15.8% with chemotherapy/chemoradiation vs. 20.3% with R2 surgical debulking (Log-rank p=0.567), but both rates were higher than best palliative care (0.0%, Log-rank p=0.0004). Three-year overall survival rates were respectively 62.0%, 70.8% and 0.0% (Log-rank p<0.0001). Chemotherapy/chemoradiation (HR 0.33, p=0.028) and R2 surgical debulking with or without chemotherapy/chemoradiation (HR 0.23, p=0.005) were independent predictors of improved progression-free survival on multivariate analysis. In conclusion, both chemotherapy/chemoradiation alone and R2 surgery with or without chemotherapy/chemoradiation provide a survival benefit over palliative care in nonresectable locally recurrent rectal cancer. However, considering that pelvic debulking is burdened by a high rate of complications, and considering its negligible impact on progression-free survival and overall survival when associated to medical therapy, surgery should be avoided in this setting.<br />Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
- Subjects :
- Humans
Male
Female
Middle Aged
Aged
Adult
Treatment Outcome
Chemoradiotherapy methods
Aged, 80 and over
Rectal Neoplasms therapy
Rectal Neoplasms pathology
Rectal Neoplasms surgery
Rectal Neoplasms mortality
Palliative Care methods
Neoplasm Recurrence, Local
Cytoreduction Surgical Procedures methods
Subjects
Details
- Language :
- English
- ISSN :
- 2038-2529
- Volume :
- 110
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Tumori
- Publication Type :
- Academic Journal
- Accession number :
- 38726768
- Full Text :
- https://doi.org/10.1177/03008916241253130