The Evolution of Multimodality Treatment of Rectal Cancer

Menée en Italie à partir de données 2000-2014 portant sur 1 064 patients atteints d'un cancer rectal localement avancé (âge médian : 64 ans ; 61,5 % d'hommes), cette étude multicentrique analyse l'effet, sur la survie globale ou la survie sans maladie, de l'allongement du délai entre la fin de la radiochimiothérapie et la chirurgie

Résumé en anglais

At the turn of the century, prospective randomized clinical trials supported the use of neoadjuvant chemoradiation therapy (nCRT) prior to total mesorectal excision (TME) of locally advanced rectal cancers (LARC). Few studies have determined the optimal time interval between nCRT and surgery, which is traditionally 6 to 12 weeks with the fundamental intent that extending the time interval to TME achieves further tumor regression or a pathologic complete response.In this issue of JAMA Surgery, Deidda et al evaluate the surgical and oncological outcomes of patients who have had minimal to no response after completion of nCRT in a retrospective multicenter cohort study. One thousand sixty-four patients from 12 Italian medical centers were divided into 2 groups, determined by the time interval between nCRT and surgery: shorter (≤8 weeks) vs longer waiting time (>8 weeks). A longer waiting time was associated with significantly worse 5- and 10-year disease-free survival (DFS) and overall survival rates and increased surgical morbidity and mortality. As pointed out by the authors, limitations of this study include its retrospective design, as it is difficult to determine factors that delayed surgery beyond 8 weeks, eg, surgeon or patient preference. Were the surgeons delaying surgery to allow more time for tumor regression in patients with more advanced pathology?