BACKGROUND: Neoadjuvant chemoradiotherapy (NACTRT) improves local recurrence rate in locally advanced (LA) @entity5 with no survival benefit. Pathological complete response (pCR) post-NACTRT is associated with improved outcome. Debate is ongoing as to when would be the opportune time to operate. AIM: To determine if greater down-staging can be achieved by a longer time interval from NACTRT to surgery ( @entity5 [ @entity5 ]) and whether this would impact sphincter saving surgery rates and early relapse rates. MATERIALS AND METHODS: A retrospective analysis of a prospectively maintained database of @entity1 with LA @entity420 treated from January 2012 to August 2013 was carried out. One hundred and ten @entity1 who completed NACTRT (50 Gy/25 fractions with @entity416 825 mg/m(2) twice daily) followed by surgical resection were included. For response evaluation @entity1 were divided into two groups, Group 1 ( @entity5  <=60 days, n = 42) and 2 ( @entity5 >60 days, n = 68). Tumor down-staging, pCR rate, @entity5 regression grade (TRG) post-NACTRT and relapse rates were correlated with @entity5 . RESULTS: Of 110 @entity1 (median age: 49 years (21-73), 71% males; 18 (16.5%) with signet ring histology) 96% @entity1 underwent an R0 resection. Post-NACTRT, CR was attained in 5 (4.5%), partial response in 98 (89%) and stable disease in 7 (6.4%) @entity1 . Median time from completion of NACTRT to surgery was 64.5 days (6-474). Median lymph nodes harvested were 10 (1-50). Overall, 22 (20%) @entity1 achieved pCR. 26 (62%) @entity1 in Group 1 compared to 36 (53%) in Group 2 underwent @entity1690 ( @entity1690 ) (P = 0.357). Six @entity1 (14%) in Group 1 and 16 (24%) in Group 2 achieved pCR (P = 0.24). Median TRG in both groups was three. CONCLUSION: Timing of surgery following NACTRT for LA @entity5 does not influence pathological response, ability to perform @entity1690 or disease-free survival. There is no incremental benefit of delaying the surgery though this needs to be confirmed in a prospective randomized trial.

Down-staging following neoadjuvant chemo-radiotherapy for locally advanced XXXX : Does timing of surgery really matter?

@entity1 :: ('9606', 'Species') :: ['patients'] @entity1690 :: ('MESH:D046628', 'Disease') :: ['SSS', 'sphincter sparing surgery'] @entity416 :: ('MESH:C110904', 'Chemical') :: ['capecitabine'] @entity5 :: ('MESH:D009369', 'Disease') :: ['tumor', 'TRS', 'rectal cancer', 'tumor regression score'] @entity420 :: ('MESH:D000230', 'Disease') :: ['rectal adenocarcinoma']
@entity5 :: (MESH:D009369,Disease) :: ['rectal cancer']
