Long-term follow-up of patients with rectal cancer managed by local excision with and without adjuvant irradiation

Arnab Chakravarti, Carolyn Compton, Paul C. Shellito, William C. Wood, Jerome Landry, Shelley R. Machuta, Donald Kaufman, Marek Ancukiewicz, Christopher G. Willett

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Abstract

Objective: The long-term outcomes of patients undergoing local excision with or without pelvic irradiation were examined to define the role of adjuvant irradiation after local excision of T1 and T2 rectal cancers. Methods: Ninety-nine patients with T1 or T2 rectal cancers underwent local excision with or without adjuvant irradiation at Massachusetts General Hospital and Emory University Hospital between January 1966 and January 1997. Of these, 52 patients were treated by local excision alone and 47 patients by local excision plus adjuvant irradiation. Twenty-six of these 47 patients were treated by irradiation in combination with 5-fluorouracil chemotherapy. The outcomes of these groups were compared. Results: The 5-year actuarial local control and recurrence-free survival rates were 72% and 66%, respectively, for the local excision alone group and 90% and 74%, respectively, for the adjuvant irradiation group. This improvement in outcome was evident despite the presence of a higher-risk patient population in the adjuvant irradiation group. Adverse pathologic features such as poorly differentiated histology and lymphatic or blood vessel invasion decreased local control and recurrence-free survival rates in the local excision only group. Adjuvant irradiation significantly improved 5-year outcomes in patients with high-risk pathologic features. Four cases of late local recurrence were seen at 64, 72, 86, and 91 months in the adjuvant irradiation group. Conclusions: The authors recommend adjuvant chemoradiation for all patients undergoing local excision for T2 tumors, and for T1 tumors with high-risk pathologic features. The four cases of late local failures beyond 5 years in the adjuvant irradiation group underscores the need for careful long-term follow-up in these patients.

Original languageEnglish (US)
Pages (from-to)49-54
Number of pages6
JournalAnnals of Surgery
Volume230
Issue number1
DOIs
StatePublished - Jul 1999
Externally publishedYes

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Rectal Neoplasms
Recurrence
Survival Rate
Lymphatic Vessels
Fluorouracil
General Hospitals
Blood Vessels
Neoplasms
Histology
Drug Therapy

ASJC Scopus subject areas

  • Surgery

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Long-term follow-up of patients with rectal cancer managed by local excision with and without adjuvant irradiation. / Chakravarti, Arnab; Compton, Carolyn; Shellito, Paul C.; Wood, William C.; Landry, Jerome; Machuta, Shelley R.; Kaufman, Donald; Ancukiewicz, Marek; Willett, Christopher G.

In: Annals of Surgery, Vol. 230, No. 1, 07.1999, p. 49-54.

Research output: Contribution to journalArticle

Chakravarti, A, Compton, C, Shellito, PC, Wood, WC, Landry, J, Machuta, SR, Kaufman, D, Ancukiewicz, M & Willett, CG 1999, 'Long-term follow-up of patients with rectal cancer managed by local excision with and without adjuvant irradiation', Annals of Surgery, vol. 230, no. 1, pp. 49-54. https://doi.org/10.1097/00000658-199907000-00008
Chakravarti, Arnab ; Compton, Carolyn ; Shellito, Paul C. ; Wood, William C. ; Landry, Jerome ; Machuta, Shelley R. ; Kaufman, Donald ; Ancukiewicz, Marek ; Willett, Christopher G. / Long-term follow-up of patients with rectal cancer managed by local excision with and without adjuvant irradiation. In: Annals of Surgery. 1999 ; Vol. 230, No. 1. pp. 49-54.
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AU - Chakravarti, Arnab

AU - Compton, Carolyn

AU - Shellito, Paul C.

AU - Wood, William C.

AU - Landry, Jerome

AU - Machuta, Shelley R.

AU - Kaufman, Donald

AU - Ancukiewicz, Marek

AU - Willett, Christopher G.

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N2 - Objective: The long-term outcomes of patients undergoing local excision with or without pelvic irradiation were examined to define the role of adjuvant irradiation after local excision of T1 and T2 rectal cancers. Methods: Ninety-nine patients with T1 or T2 rectal cancers underwent local excision with or without adjuvant irradiation at Massachusetts General Hospital and Emory University Hospital between January 1966 and January 1997. Of these, 52 patients were treated by local excision alone and 47 patients by local excision plus adjuvant irradiation. Twenty-six of these 47 patients were treated by irradiation in combination with 5-fluorouracil chemotherapy. The outcomes of these groups were compared. Results: The 5-year actuarial local control and recurrence-free survival rates were 72% and 66%, respectively, for the local excision alone group and 90% and 74%, respectively, for the adjuvant irradiation group. This improvement in outcome was evident despite the presence of a higher-risk patient population in the adjuvant irradiation group. Adverse pathologic features such as poorly differentiated histology and lymphatic or blood vessel invasion decreased local control and recurrence-free survival rates in the local excision only group. Adjuvant irradiation significantly improved 5-year outcomes in patients with high-risk pathologic features. Four cases of late local recurrence were seen at 64, 72, 86, and 91 months in the adjuvant irradiation group. Conclusions: The authors recommend adjuvant chemoradiation for all patients undergoing local excision for T2 tumors, and for T1 tumors with high-risk pathologic features. The four cases of late local failures beyond 5 years in the adjuvant irradiation group underscores the need for careful long-term follow-up in these patients.

AB - Objective: The long-term outcomes of patients undergoing local excision with or without pelvic irradiation were examined to define the role of adjuvant irradiation after local excision of T1 and T2 rectal cancers. Methods: Ninety-nine patients with T1 or T2 rectal cancers underwent local excision with or without adjuvant irradiation at Massachusetts General Hospital and Emory University Hospital between January 1966 and January 1997. Of these, 52 patients were treated by local excision alone and 47 patients by local excision plus adjuvant irradiation. Twenty-six of these 47 patients were treated by irradiation in combination with 5-fluorouracil chemotherapy. The outcomes of these groups were compared. Results: The 5-year actuarial local control and recurrence-free survival rates were 72% and 66%, respectively, for the local excision alone group and 90% and 74%, respectively, for the adjuvant irradiation group. This improvement in outcome was evident despite the presence of a higher-risk patient population in the adjuvant irradiation group. Adverse pathologic features such as poorly differentiated histology and lymphatic or blood vessel invasion decreased local control and recurrence-free survival rates in the local excision only group. Adjuvant irradiation significantly improved 5-year outcomes in patients with high-risk pathologic features. Four cases of late local recurrence were seen at 64, 72, 86, and 91 months in the adjuvant irradiation group. Conclusions: The authors recommend adjuvant chemoradiation for all patients undergoing local excision for T2 tumors, and for T1 tumors with high-risk pathologic features. The four cases of late local failures beyond 5 years in the adjuvant irradiation group underscores the need for careful long-term follow-up in these patients.

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