Wait-and-See Policy for Clinical Complete Responders After Chemoradiation for Rectal Cancer
Top Cited Papers
- 10 December 2011
- journal article
- clinical trial
- Published by American Society of Clinical Oncology (ASCO) in Journal of Clinical Oncology
- Vol. 29 (35), 4633-4640
- https://doi.org/10.1200/jco.2011.37.7176
Abstract
Purpose Neoadjuvant chemoradiotherapy for rectal cancer can result in complete disappearance of tumor and involved nodes. In patients without residual tumor on imaging and endoscopy (clinical complete response [cCR]) a wait-and-see-policy (omission of surgery with follow-up) might be considered instead of surgery. The purpose of this prospective cohort study was to evaluate feasibility and safety of a wait-and-see policy with strict selection criteria and follow-up. Patients and Methods Patients with a cCR after chemoradiotherapy were prospectively selected for the wait-and-see policy with magnetic resonance imaging (MRI) and endoscopy plus biopsies. Follow-up was performed 3 to 6 monthly and consisted of MRI, endoscopy, and computed tomography scans. A control group of patients with a pathologic complete response (pCR) after surgery was identified from a prospective cohort study. Functional outcome was measured with the Memorial Sloan-Kettering Cancer Center (MSKCC) bowel function questionnaire and Wexner incontinence score. Long-term outcome was estimated by using Kaplan-Meier curves. Results Twenty-one patients with cCR were included in the wait-and-see policy group. Mean follow-up was 25 ± 19 months. One patient developed a local recurrence and had surgery as salvage treatment. The other 20 patients are alive without disease. The control group consisted of 20 patients with a pCR after surgery who had a mean follow-up of 35 ± 23 months. For these patients with a pCR, cumulative probabilities of 2-year disease-free survival and overall survival were 93% and 91%, respectively. Conclusion 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. The proposed selection criteria and follow-up could form the basis for future randomized studies.Keywords
This publication has 23 references indexed in Scilit:
- Transanal Endoscopic Microsurgery for Residual Rectal Cancer After Neoadjuvant Chemoradiation Therapy Is Associated With Significant Immediate Pain and Hospital Readmission RatesDiseases of the Colon & Rectum, 2011
- Accuracy of Gadofosveset-enhanced MRI for Nodal Staging and Restaging in Rectal CancerAnnals of Surgery, 2011
- Diffusion-Weighted MRI for Selection of Complete Responders After Chemoradiation for Locally Advanced Rectal Cancer: A Multicenter StudyAnnals of Surgical Oncology, 2011
- Patient-Reported Outcomes After Neoadjuvant Chemoradiotherapy for Rectal CancerAnnals of Surgery, 2011
- Transanal endoscopic microsurgery for the treatment of rectal cancer: comparison of wound complication rates with and without neoadjuvant radiation therapySurgical Endoscopy, 2009
- Complete Clinical Response After Preoperative Chemoradiation in Rectal Cancer: Is a “Wait and See” Policy Justified?Diseases of the Colon & Rectum, 2008
- Neoadjuvant Chemoradiation and Local Excision for T2-3 Rectal CancerAnnals of Surgical Oncology, 2007
- Operative Versus Nonoperative Treatment for Stage 0 Distal Rectal Cancer Following Chemoradiation TherapyAnnals of Surgery, 2004
- Classification of Surgical ComplicationsAnnals of Surgery, 2004
- Physiological and clinical outcome of anterior sphincteroplastyBritish Journal of Surgery, 1996