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Interval to surgery after neoadjuvant treatment for colorectal cancer Wasserberg NWorld J Gastroenterol 2014[Apr]; 20 (15): 4256-62The current standard treatment of low-lying locally advanced rectal cancer consists of chemoradiation followed by radical surgery. The interval between chemoradiation and surgery varied for many years until the 1999 Lyon R90-01 trial which compared the effects of a short (2-wk) and long (6-wk) interval. Results showed a better clinical tumor response (71.7% vs 53.1%) and higher rate of positive and pathologic tumor regression (26% vs 10.3%) after the longer interval. Accordingly, a 6-wk interval between chemoradiation and surgery was set to balance the oncological results with the surgical complexity. However, several recent retrospective studies reported that prolonging the interval beyond 8 or even 12 wk may lead to significantly higher rates of tumor downstaging and pathologic complete response. This in turn, according to some reports, may improve overall and disease-free survival, without increasing the surgical difficulty or complications. This work reviews the data on the effect of different intervals, derived mostly from retrospective analyses using a wide variation of treatment protocols. Prospective randomized trials are currently ongoing.|Anal Canal/pathology[MESH]|Chemoradiotherapy/*methods[MESH]|Colorectal Neoplasms/*drug therapy/*radiotherapy/*surgery[MESH]|Combined Modality Therapy/methods[MESH]|Disease-Free Survival[MESH]|Humans[MESH]|Neoadjuvant Therapy/*methods[MESH]|Neoplasm Staging[MESH]|Preoperative Period[MESH]|Prognosis[MESH]|Randomized Controlled Trials as Topic[MESH]|Retrospective Studies[MESH]|Treatment Outcome[MESH] |
