Does A Longer Waiting Period After Neoadjuvant Radio-chemotherapy Improve the Oncological Prognosis of Rectal Cancer?

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Lefèvre, Jérémie | Mineur, Laurent | Cachanado, Marine | Denost, Quentin | Rouanet, Philippe | de Chaisemartin, Cécile | Meunier, B. | Mehrdad, Jafari | Cotte, Eddy | Desramé, Jérôme | Karoui, Mehdi | Benoist, Stéphane | Kirzin, Sylvain | Berger, Anne | Panis, Yves | Piessen, Guillaume | Saudemont, Alain | Prudhomme, Michel | Peschaud, Frédérique | Dubois, Anne | Loriau, Jérôme | Tuech, Jean-Jacques | Meurette, Guillaume | Lupinacci, Renato | Goasguen, Nicolas | Creavin, Ben | Simon, Tabassome | Parc, Yann | (greccar), French Research Group of Rectal Cancer Surgery

Edité par CCSD ; Lippincott, Williams & Wilkins -

International audience. Objective: The aim of this study was to report the 3-year survival results of the GRECCAR-6 trial.Summary background data: Current data on the effect of an extended interval between radiochemotherapy (RCT) and resection for rectal cancer on the rate of complete pathological response (pCR = ypT0N0) is controversial. Furthermore, its effect on oncological outcomes is unknown.Methods: The GRECCAR-6 trial was a phase III, multicenter, randomized, open-label, parallel-group, controlled trial. Patients with cT3/T4 or TxN+ tumors of the mid or lower rectum who had received RCT (45-50 Gy with 5-fluorouracil or capecitabine) were included and randomized into a 7- or 11-week waiting period. Primary endpoint was the pCR rate. Secondary endpoints were 3-year overall (OS), disease-free survival (DFS), and recurrence rates.Results: A total of 265 patients from 24 participating centers were enrolled. A total of 253 patients underwent a mesorectal excision. Overall pCR rate was 17% (43/253). Mean follow-up from surgical resection was 32 ± 8 months. Twenty-four deaths occurred with an 89% OS at 3 years. DFS was 68.7% at 3 years (75 recurrences). Three-year local and distant recurrences were 7.9% and 23.8%, respectively. The randomization group had no impact on the 3-year OS (P = 0.8868) or DFS (P = 0.9409). Distant (P = 0.7432) and local (P = 0.3944) recurrences were also not influenced by the waiting period. DFS was independently influenced by 3 factors: circumferential radial margin (CRM) ≤1 mm [hazard ratio (HR) = 2.03; 95% confidence interval (CI), 1.17-3.51], ypT3-T4 (HR = 2.69; 95% CI, 1.19-6.08) and positive lymph nodes (HR = 3.62; 95% CI, 1.89-6.91).Conclusion: Extending the waiting period by 4 weeks following RCT has no influence on the oncological outcomes of T3/T4 rectal cancers.

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