Browsing by Author "Datta, Debanjali"
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Item Non-operative management in low-lying rectal cancers undergoing chemoradiation(Wolters Kluwer - Medknow, 2024-01) Datta, Debanjali; Engineer, Reena; Saklani, Avanish; D’souza, Ashwin; Baheti, Akshay; Kumar, Suman; Krishnatry, Rahul; Ostwal, Vikas; Ramaswamy, Anant; Patil, PrachiPurpose: To evaluate the outcomes of post?neoadjuvant chemoradiation (NACTRT) wait?and?watch Strategy (WWS) in distal rectal cancers. Materials and Methods: All consecutive patients from December 2012 to 2019 diagnosed with distal rectal tumors (T2?T4 N0?N+) having a complete or near?complete response (cCR or nCR, respectively) post?NACTRT and wishing for the non?surgical treatment option of WWS were included in this study. Patients were observed with 3 monthly magnetic resonance imaging (MRIs), sigmoidoscopies, and digital rectal examination for 2 years and 6 monthly thereafter. Organ preservation rate (OPR), local regrowth rate (LRR), non?regrowth recurrence?free survival (NR?RFS) and overall survival (OAS) were estimated using the Kaplan–Meier method, and factors associated with LRR were identified on univariate and multivariate analysis using the log?rank test (P < 0.05 significant). Results: Sixty?one consecutive patients post?NACTRT achieving cCR[44 (72%)] and nCR[17 (28%)], respectively, were identified. All patients received pelvic radiotherapy at a dose of 45–50Gy conventional fractionation and concurrent capecitabine. An additional boost dose with either an external beam or brachytherapy was given to 39 patients. At a median follow?up of 39 months, 11 (18%) patients had local regrowth, of which seven were salvaged with surgery and the rest are alive with the disease, as they refused surgery. The overall OPR, NR?RFS, and OS were 83%, 95%, and 98%, respectively. Seven (11%) patients developed distant metastasis, of which six underwent metastatectomy and are alive and well. LRR was higher in patients with nCR versus cCR (P = 0.05). Conclusion: The WWS is a safe non?operative alternative management for selected patients attaining cCR/nCR after NACTRT with excellent outcomes.