Journal Article10.1016/J.IJROBP.2013.12.012
Local Recurrence After Complete Clinical Response and Watch and Wait in Rectal Cancer After Neoadjuvant Chemoradiation: Impact of Salvage Therapy on Local Disease Control
Angelita Habr-Gama,Joaquim Gama-Rodrigues,Guilherme Pagin São Julião,Igor Proscurshim,Charles Sabbagh,Patricio B. Lynn,Rodrigo Oliva Perez +6 more
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TL;DR: Local recurrence may develop in 31% of patients with initial cCR when early regrowths (≤ 12 months) and late recurrences are grouped together, and more than half of these recurrence develop within 12 months of follow-up.
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Abstract: Purpose To review the risk of local recurrence and impact of salvage therapy after Watch and Wait for rectal cancer with complete clinical response (cCR) after chemoradiation therapy (CRT). Methods and Materials Patients with cT2-4N0-2M0 distal rectal cancer treated with CRT (50.4-54 Gy + 5-fluorouracil-based chemotherapy) and cCR at 8 weeks were included. Patients with cCR were enrolled in a strict follow-up program with no immediate surgery (Watch and Wait). Local recurrence-free survival was compared while taking into account Watch and Wait strategy alone and Watch and Wait plus salvage. Results 90 of 183 patients experienced cCR at initial assessment after CRT (49%). When early tumor regrowths (up to and including the initial 12 months of follow-up) and late recurrences were considered together, 28 patients (31%) experienced local recurrence (median follow-up time, 60 months). Of those, 26 patients underwent salvage therapy, and 2 patients were not amenable to salvage. In 4 patients, local re-recurrence developed after Watch and Wait plus salvage. The overall salvage rate for local recurrence was 93%. Local recurrence-free survival at 5 years was 69% (all local recurrences) and 94% (after salvage procedures). Thirteen patients (14%) experienced systemic recurrence. The 5-year cancer-specific overall survival and disease-free survival for all patients (including all recurrences) were 91% and 68%, respectively. Conclusions Local recurrence may develop in 31% of patients with initial cCR when early regrowths (≤12 months) and late recurrences are grouped together. More than half of these recurrences develop within 12 months of follow-up. Salvage therapy is possible in ≥90% of recurrences, leading to 94% local disease control, with 78% organ preservation.
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Citations
A rectal cancer feasibility study with an embedded phase III trial design assessing magnetic resonance tumour regression grade (mrTRG) as a novel biomarker to stratify management by good and poor response to chemoradiotherapy (TRIGGER): study protocol for a randomised controlled trial.
Nick J. Battersby,Mit Dattani,Sheela Rao,David Cunningham,Diana Tait,Richard Adams,Brendan Moran,Shelize Khakoo,P. Tekkis,Shahnawaz Rasheed,Alex H. Mirnezami,Philip Quirke,Nicholas P. West,Iris D. Nagtegaal,Irene Chong,Anguraj Sadanandam,Nicola Valeri,Karen Thomas,Michelle L Frost,Gina Brown +19 more
TL;DR: TRIGGER as mentioned in this paper is a multicentre, open, interventional, randomised control feasibility study with an embedded phase III design, which aims to determine whether patients with locally advanced rectal cancer can be recruited and subsequently randomised into a control trial that offers MRI-directed patient management according to radiological response to CRT.
Impact of PET/CT for Restaging Patients With Locally Advanced Rectal Cancer After Neoadjuvant Chemoradiation.
Eric C. Sorenson,Fernando Lambreton,Jian Q. Yu,Tianyu Li,Crystal S. Denlinger,Joshua E. Meyer,Elin R. Sigurdson,Jeffrey M. Farma +7 more
TL;DR: PET/CT may be useful in identifying patients who did not achieve pCR, as well as overall survival in patients undergoing CRT for rectal cancer.
Value of intra-tumor heterogeneity evaluated by diffusion-weighted MRI for predicting pathological stages and therapeutic responses to chemoradiotherapy in lower rectal cancer.
Michihiro Kudou,Masayoshi Nakanishi,Yoshiaki Kuriu,Yasutoshi Murayama,Tomohiro Arita,Mitsuo Kishimoto,Eiichi Konishi,Mariko Goto,Kei Yamada,Eigo Otsuji +9 more
TL;DR: Diffusion-weighted MRI (DWI) has the potential to reveal intra-tumor structural heterogeneity consisting of stroma through an evaluation of uniformity on DWI and is useful for predicting T3 or deeper tumor invasion, pathological N(+), and the therapeutic effects of pCRT.
FDG-PET/MRI for Nonoperative Management of Rectal Cancer: A Prospective Pilot Study
Semra Ince,Malak Itani,Lauren E. Henke,Radhika Smith,Paul E. Wise,Matthew G. Mutch,Sean C. Glasgow,Matthew L. Silviera,Katrina S. Pedersen,Steven R. Hunt,Hyun Sook Kim,Tyler J. Fraum +11 more
TL;DR: In this paper , a pilot study was conducted to determine whether FDG-PET/MRI alters clinical response assessments among stage I-III rectal cancer patients undergoing total neoadjuvant therapy (TNT) followed by NOM, relative to MRI alone.
Additional file 20 of A meta-analysis of the watch-and-wait strategy versus total mesorectal excision for rectal cancer exhibiting complete clinical response after neoadjuvant chemoradiotherapy
Yu Guilin,Lu Wenqing,Jiao Zhouguang,Qiao Jun,Ma Shiyang,Liu Xin +5 more
- 19 Oct 2021
Abstract: Additional file 20. Search terms and database.
References
Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results.
Angelita Habr-Gama,Rodrigo Oliva Perez,Wladimir Nadalin,Jorge Sabbaga,Ulysses Ribeiro,Afonso Henrique da Silva e Sousa,Fábio Campos,Desidério Roberto Kiss,Joaquim Gama-Rodrigues +8 more
TL;DR: Stage 0 rectal cancer disease is associated with excellent long-term results irrespective of treatment strategy and Surgical resection may not lead to improved outcome in this situation and may be associated with high rates of temporary or definitive stoma construction and unnecessary morbidity and mortality rates.
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Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data
Monique Maas,Patty J. Nelemans,Vincenzo Valentini,Prajnan Das,Claus Rödel,Li Jen Kuo,Felipe A. Calvo,Julio Garcia-Aguilar,Rob Glynne-Jones,Karin Haustermans,Mohammed Mohiuddin,Salvatore Pucciarelli,William Small,Javier Suárez,George Theodoropoulos,Sebastiano Biondo,Sebastiano Biondo,Regina G. H. Beets-Tan,Geerard L. Beets +18 more
TL;DR: Patients with pCR after chemoradiation have better long-term outcome than do those without pCR, and pCR might be indicative of a prognostically favourable biological tumour profile with less propensity for local or distant recurrence and improved survival.
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Wait-and-See Policy for Clinical Complete Responders After Chemoradiation for Rectal Cancer
Monique Maas,Regina G. H. Beets-Tan,Doenja M. J. Lambregts,Guido Lammering,Patty J. Nelemans,Sanne M. E. Engelen,Ronald M. van Dam,Rob L. H. Jansen,Meindert N. Sosef,Jeroen W. A. Leijtens,Karel W.E. Hulsewé,Jeroen Buijsen,Geerard L. Beets +12 more
TL;DR: A wait-and-see policy with strict selection criteria, up-to-date imaging techniques, and follow-up is feasible and results in promising outcome at least as good as that of patients with a pCR after surgery.
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Complete clinical response after neoadjuvant chemoradiation therapy for distal rectal cancer: characterization of clinical and endoscopic findings for standardization.
Angelita Habr-Gama,Rodrigo Oliva Perez,Gregory Wynn,John H. Marks,Hermann Kessler,Joaquim Gama-Rodrigues +5 more
TL;DR: Strict definition of the clinical and endoscopic findings of patients experiencing complete clinical response after neoadjuvant chemoradiation therapy may provide a useful tool for the understanding of outcomes of patients managed with no immediate surgery allowing standardization of classifications and comparison between the experiences of different institutions.
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Patterns of failure and survival for nonoperative treatment of stage c0 distal rectal cancer following neoadjuvant chemoradiation therapy
Angelita Habr-Gama,Rodrigo Oliva Perez,Igor Proscurshim,Fábio Campos,Wladimir Nadalin,Desidério Roberto Kiss,Joaquim Gama-Rodrigues +6 more
TL;DR: Even though surgery remains the standard treatment for rectal cancer, nonoperative treatment after complete clinical response following neoadjuvant CRT may be safe and associated with good survival rates in a highly selected group of patients.
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