Sphincter-sparing treatment for distal rectal adenocarcinoma

Glenn D. Steele*, James E. Herndon, Ron Bleday, Anthony Russell, Al Benson, Maha Hussain, Anne Burgess, Joel E. Tepper, Robert J. Mayer

*Corresponding author for this work

Research output: Contribution to journalArticle

226 Citations (Scopus)

Abstract

Background: Studies suggest that the anal sphincter can be preserved in some patients with distal rectal adenocarcinoma (DRA), but this has not been validated in any prospective multi-institutional trial. Methods: To test the hypothesis that the anal sphincter can be preserved in some patients with DRA, the Cancer and Leukemia Group B and collaborators reviewed 177 patients who had T1/T2 adenocarcinomas ≤ 4 cm in diameter, which encompassed ≤ 40% of bowel wall circumference, and were ≤ 10 cm from the dentate line. Of the 177 patients, 59 patients who were eligible for the study had T1 adenocarcinomas and received no further treatment; 51 eligible T2 patients received external beam irradiation (5400 cGY/30 fractions 5 days/week) and 5- fluorouracil (500 mg/m2 IV d1-3, d29-31) after local excision. Results: At 48 months median follow-up, 6-year survival and failure-free survival rates of the eligible patients are 85% and 78% respectively. Three patients died of unrelated disease. Two patients were treated for second primary colorectal tumors; both remain disease free (NED). Another eight patients died of disease, four with distant recurrence only. One T1 patient is alive with distant disease. Two T1 and seven T2 patients experienced isolated local recurrences; all underwent salvage abdominoperineal resection (APR). After APR, one T1 and four of seven T2 patients were NED at the time of last visit (2-7 years). One T1 patient died of local and distant disease. Three of seven T2 patients died with distant disease. Conclusions: We conclude that sphincter preservation can be achieved with excellent cancer control without initial sacrifice of anal function in most patients. After local recurrence, salvage resection appears effective, but longer follow-up time of local and distant disease-free survival is advised before extrapolation to patients with T3 primaries.

Original languageEnglish (US)
Pages (from-to)433-441
Number of pages9
JournalAnnals of Surgical Oncology
Volume6
Issue number5
DOIs
StatePublished - Jul 1 1999

Fingerprint

Adenocarcinoma
Therapeutics
Anal Canal
Recurrence
Rectal Neoplasms
Fluorouracil
Disease-Free Survival
Colorectal Neoplasms
Leukemia
Survival Rate

Keywords

  • Rectal cancer
  • Sphincter prevervation

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Steele, Glenn D. ; Herndon, James E. ; Bleday, Ron ; Russell, Anthony ; Benson, Al ; Hussain, Maha ; Burgess, Anne ; Tepper, Joel E. ; Mayer, Robert J. / Sphincter-sparing treatment for distal rectal adenocarcinoma. In: Annals of Surgical Oncology. 1999 ; Vol. 6, No. 5. pp. 433-441.
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title = "Sphincter-sparing treatment for distal rectal adenocarcinoma",
abstract = "Background: Studies suggest that the anal sphincter can be preserved in some patients with distal rectal adenocarcinoma (DRA), but this has not been validated in any prospective multi-institutional trial. Methods: To test the hypothesis that the anal sphincter can be preserved in some patients with DRA, the Cancer and Leukemia Group B and collaborators reviewed 177 patients who had T1/T2 adenocarcinomas ≤ 4 cm in diameter, which encompassed ≤ 40{\%} of bowel wall circumference, and were ≤ 10 cm from the dentate line. Of the 177 patients, 59 patients who were eligible for the study had T1 adenocarcinomas and received no further treatment; 51 eligible T2 patients received external beam irradiation (5400 cGY/30 fractions 5 days/week) and 5- fluorouracil (500 mg/m2 IV d1-3, d29-31) after local excision. Results: At 48 months median follow-up, 6-year survival and failure-free survival rates of the eligible patients are 85{\%} and 78{\%} respectively. Three patients died of unrelated disease. Two patients were treated for second primary colorectal tumors; both remain disease free (NED). Another eight patients died of disease, four with distant recurrence only. One T1 patient is alive with distant disease. Two T1 and seven T2 patients experienced isolated local recurrences; all underwent salvage abdominoperineal resection (APR). After APR, one T1 and four of seven T2 patients were NED at the time of last visit (2-7 years). One T1 patient died of local and distant disease. Three of seven T2 patients died with distant disease. Conclusions: We conclude that sphincter preservation can be achieved with excellent cancer control without initial sacrifice of anal function in most patients. After local recurrence, salvage resection appears effective, but longer follow-up time of local and distant disease-free survival is advised before extrapolation to patients with T3 primaries.",
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Steele, GD, Herndon, JE, Bleday, R, Russell, A, Benson, A, Hussain, M, Burgess, A, Tepper, JE & Mayer, RJ 1999, 'Sphincter-sparing treatment for distal rectal adenocarcinoma', Annals of Surgical Oncology, vol. 6, no. 5, pp. 433-441. https://doi.org/10.1007/s10434-999-0433-5

Sphincter-sparing treatment for distal rectal adenocarcinoma. / Steele, Glenn D.; Herndon, James E.; Bleday, Ron; Russell, Anthony; Benson, Al; Hussain, Maha; Burgess, Anne; Tepper, Joel E.; Mayer, Robert J.

In: Annals of Surgical Oncology, Vol. 6, No. 5, 01.07.1999, p. 433-441.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Sphincter-sparing treatment for distal rectal adenocarcinoma

AU - Steele, Glenn D.

AU - Herndon, James E.

AU - Bleday, Ron

AU - Russell, Anthony

AU - Benson, Al

AU - Hussain, Maha

AU - Burgess, Anne

AU - Tepper, Joel E.

AU - Mayer, Robert J.

PY - 1999/7/1

Y1 - 1999/7/1

N2 - Background: Studies suggest that the anal sphincter can be preserved in some patients with distal rectal adenocarcinoma (DRA), but this has not been validated in any prospective multi-institutional trial. Methods: To test the hypothesis that the anal sphincter can be preserved in some patients with DRA, the Cancer and Leukemia Group B and collaborators reviewed 177 patients who had T1/T2 adenocarcinomas ≤ 4 cm in diameter, which encompassed ≤ 40% of bowel wall circumference, and were ≤ 10 cm from the dentate line. Of the 177 patients, 59 patients who were eligible for the study had T1 adenocarcinomas and received no further treatment; 51 eligible T2 patients received external beam irradiation (5400 cGY/30 fractions 5 days/week) and 5- fluorouracil (500 mg/m2 IV d1-3, d29-31) after local excision. Results: At 48 months median follow-up, 6-year survival and failure-free survival rates of the eligible patients are 85% and 78% respectively. Three patients died of unrelated disease. Two patients were treated for second primary colorectal tumors; both remain disease free (NED). Another eight patients died of disease, four with distant recurrence only. One T1 patient is alive with distant disease. Two T1 and seven T2 patients experienced isolated local recurrences; all underwent salvage abdominoperineal resection (APR). After APR, one T1 and four of seven T2 patients were NED at the time of last visit (2-7 years). One T1 patient died of local and distant disease. Three of seven T2 patients died with distant disease. Conclusions: We conclude that sphincter preservation can be achieved with excellent cancer control without initial sacrifice of anal function in most patients. After local recurrence, salvage resection appears effective, but longer follow-up time of local and distant disease-free survival is advised before extrapolation to patients with T3 primaries.

AB - Background: Studies suggest that the anal sphincter can be preserved in some patients with distal rectal adenocarcinoma (DRA), but this has not been validated in any prospective multi-institutional trial. Methods: To test the hypothesis that the anal sphincter can be preserved in some patients with DRA, the Cancer and Leukemia Group B and collaborators reviewed 177 patients who had T1/T2 adenocarcinomas ≤ 4 cm in diameter, which encompassed ≤ 40% of bowel wall circumference, and were ≤ 10 cm from the dentate line. Of the 177 patients, 59 patients who were eligible for the study had T1 adenocarcinomas and received no further treatment; 51 eligible T2 patients received external beam irradiation (5400 cGY/30 fractions 5 days/week) and 5- fluorouracil (500 mg/m2 IV d1-3, d29-31) after local excision. Results: At 48 months median follow-up, 6-year survival and failure-free survival rates of the eligible patients are 85% and 78% respectively. Three patients died of unrelated disease. Two patients were treated for second primary colorectal tumors; both remain disease free (NED). Another eight patients died of disease, four with distant recurrence only. One T1 patient is alive with distant disease. Two T1 and seven T2 patients experienced isolated local recurrences; all underwent salvage abdominoperineal resection (APR). After APR, one T1 and four of seven T2 patients were NED at the time of last visit (2-7 years). One T1 patient died of local and distant disease. Three of seven T2 patients died with distant disease. Conclusions: We conclude that sphincter preservation can be achieved with excellent cancer control without initial sacrifice of anal function in most patients. After local recurrence, salvage resection appears effective, but longer follow-up time of local and distant disease-free survival is advised before extrapolation to patients with T3 primaries.

KW - Rectal cancer

KW - Sphincter prevervation

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