Short-term outcomes of non-operative management in locally advanced distal rectal cancer patients after consolidation FOLFOX chemoradiotherapy: single center experience

Abstract

Aim: The major objective was to analyze the early clinical outcomes of nonoperative management (NOM) in locally advanced distal rectal cancer (LARC) patients who had a complete clinical response (cCR) with consolidation neoadjuvantchemotherapy (CNCT).Method: LARC patients with stage II/III received neoadjuvant chemoradiation (CRT), six cycles of FOLFOX and were restaged before and after CNCT. Those with incomplete response after CRT and remaining residual after FOLFOX underwent total mesorectal excision (TME). Patients are followed every 3 months for 2 years and every 6 months thereafter.Results: Between September 2016 and November 2018, 54 patients were enrolled in the prospective study. 28 (51.9%) patients underwent TME after CRT and 26 (48.1%) patients received CNCT. After CNCT 18 (69.2%) patients with cCR were followed with NOM and 8 (30.8%) patients were recommended TME due to incomplete response. Median follow-up was 23.4 months and median height from dentate line was 3 cm. Four (22.2%) patients developed local regrowths and were treated with salvage surgery. In addition one of these patients had distant metastasis. Overall survival was 94.4% and disease-free survival was 77.7%.Conclusion: NOM resulted in satisfying rectal preservation and pelvic tumour control in selected patients who had cCR after CNCT.