ABSTRACT
PURPOSE: Pathologic downstaging of rectal cancer has been suggested to be associated with the time interval from chemoradiotherapy (CRT) completion to surgery. We aimed to evaluate the effect of this time interval for patients with rectal cancer on the pathologic response. METHODS: All patients with rectal cancer undergoing neoadjuvant CRT with evaluable data were selected from among the Health Insurance Review and Assessment Service data. Patients were divided into groups according to the time between CRT and surgery. CRT responses were analyzed. RESULTS: Two hundred forty-nine patients were included, of whom 86 (34.5%) were in the 5- to 7-week interval, 113 (45.4%) in the 7- to 9-week interval, 38 (15.3%) in the 9- to 11-week interval, and 12 (4.8%) in the >11-week interval. The median time interval between CRT completion and surgery was 7.4 weeks (range: 5–22.7 weeks; interquartile range, 6.7–8.7 weeks). Surgery 9–11 weeks after CRT completion resulted in the highest, but not statistically significant, pathologic complete response (pCR) rate (3 patients, 8.6%; P = 0.886), no pCR was noted in the >11-week interval group. Results for downstaging in the 9- to 11-week interval group were as follows: T downstaging, 38.2% (P = 0.735); N downstaging, 50.0% (P = 0.439); and TN downstaging, 52.9% (P = 0.087). The 3-year overall survival rates for the 5- to 7-week, 7- to 9-week, 9- to 11-week, and >11-week interval groups were 93.0%, 85.0%, 81.6%, and 91.7%, respectively (P = 0.326). CONCLUSION: Delaying surgery by 9 to 11 weeks may increase TN downstaging, but delaying for over 11 weeks may not increase additional tumor downstaging from long-course CRT.
Subject(s)
Humans , Chemoradiotherapy , Insurance, Health , Neoadjuvant Therapy , Polymerase Chain Reaction , Rectal Neoplasms , Survival RateABSTRACT
This study was performed to evaluate the actual temperature rise on the surface of Buchanan plugger using thermocouple. The heat carrier system 'System B Heatsource' (Model 1005, Analytic Technologies, Redmond, WA, USA) and the Buchanan pluggers of F, FM, M and ML sizes are used for this study. The temperature was set to 200degrees C on digital display and the power level on it was set to 10. Five thermocouples were placed in direct contact with the surface of each size of Buchanan's pluggers at 1 mm increments from the tip to the 4 mm length of shank. The heat control spring was touched for 5 seconds, and the temperature rise on the surface of the pluggers were measured at 1 sec intervals for more than 5 seconds with an accuracy of 0.01 using Data Logger. The data were statistically analyzed by one-way ANOVA. The results were as follows. 1. The position at which the temperature peaked was approximately at 1~2 mm far from the tip of Buchanan plugger (p<0.01). 2. The peak temperature was 215.25+/-2.28degrees C in F plugger, 185.94+/-2.19degrees C in FM plugger, 169.51+/-9.12degrees C in M plugger, and 160.79+/-1.27degrees C in ML plugger and the peak temperature was highest in F plugger and followed by, in descending order, FM plugger, M plugger. ML plugger showed the lowest peak temperature (p<0.01). 3. The temperature on the pluggers was decreased with the increase of touching time. This results suggest that the actual temperature on the surface of the pluggers does not correlate well with the temperature set on digital display. Heat concentrates around the tip. The larger plugger reveals lower temperature rise relatively.