Individualization of guidelines. Approach for rectal cancer in UICC stages II and III

• Published in: Chirurg Vol. 85; no. 2; pp. 125 - 130
• Main Authors: Eismann, N, Emmermann, A, Zornig, C
• Format: Journal Article
• Language: German
• Published: Germany 01-02-2014
• Subjects: Adult; Aged; Aged, 80 and over; Chemotherapy, Adjuvant; Combined Modality Therapy; Disease-Free Survival; Female; Germany; Guideline Adherence; Humans; Male; Middle Aged; Neoadjuvant Therapy; Neoplasm Recurrence, Local - mortality; Patient Care Planning; Radiotherapy, Adjuvant; Rectal Neoplasms - classification; Rectal Neoplasms - mortality; Rectal Neoplasms - pathology; Rectal Neoplasms - therapy; Rectum - pathology; Rectum - surgery; Germany
• ISSN: 1433-0385
• DOI: 10.1007/s00104-013-2551-7

The German guidelines for the therapy of rectal carcinoma in Union Internationale Contre le Cancer (UICC) stages II and III raise questions of overtherapy. This is why we have individualized the therapy in suitable isolated cases (localization in the upper third of the rectum and wider safety margins in cases of small T3).
All 131 patients with rectal cancer stages II and III, who were operated on within a time period of 4 years were retrospectively included in the study. In 30 favorable cases no radiotherapy was given and in 15 of these no chemotherapy. After an average of 57 months follow-up the course of the disease could be clarified in 95 % of the patients.
The 5-year survival rate in the whole group was 81.5 % with a local recurrence rate of 8 %. Of the patients with no additional therapy (or only adjuvant chemotherapy), 30 had a 5-year survival rate of 100 % (86.7 %) and a local recurrence rate of 6.7 % (6.7 %).
In this study it could be shown that an individualization of guidelines in special cases does not lead to a higher mortality rate or to a higher rate of local recurrence. The study highlights that chemotherapy and radiotherapy with all the negative consequences could be avoided for several patients.