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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TL;DR: Alternative approaches have emerged to streamline treatment without sacrificing oncologic outcomes, and these approaches include preoperative chemotherapy with selective use of radiation, short‐course radiotherapy delivered over 5 days, and total neoadjuvant therapy with attempted nonoperative organ‐preserving management (watch and wait).
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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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