High-dose chemoradiotherapy and watchful waiting for distal rectal cancer: a prospective observational study

Appelt, Ane L; Pløen, John; Harling, Henrik; Jensen, Frank Svendsen; Jensen, Lars Henrik; Jørgensen, Jens Christian Riis; Lindebjerg, Jan; Rafaelsen, Søren Rafael; Jakobsen, Anders

doi:10.1016/s1470-2045(15)00120-5

Cited by 484 publications

(349 citation statements)

References 28 publications

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“…In around 30% of these cases, cancer cells were found in the bowel wall [10,11]. As mentioned previously, in a similar number of cases, regrowths were seen in the bowel wall if patients had been under observation without surgery [5][6][7][8].…”

Section: Correlation Between Ccr and Pcrsupporting

confidence: 59%

“…Likewise, favourable outcomes have been reported in other studies on less numerous patient groups and with shorter follow-ups [6][7][8][9]. These showed significantly better efficacy than those obtained after treatment of local recurrence after radical surgery.…”

Section: Efficacy Of Rescue Surgerysupporting

confidence: 58%

“…Local recurrences after cCR are common, being about one third of patients [5][6][7][8]. This is opposed to around 5% relapses occurring after surgery.…”

Section: Efficacy Of Rescue Surgerymentioning

confidence: 99%

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Rectal cancer patients can be treated conservatively

Bujko

2017

Nowotwory. Journal of Oncology

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Introduction. The strategy of undertaking a watch-and-wait policy without surgical treatment is currently being debated in those patients where complete clinical response/regression (cCR) has been diagnosed after preoperative irradiation. Its proponents maintain that there is sufficient evidence of efficacy allowing routine use. This means that following preoperative chemoradiotherapy, each patient should be investigated for cCR. If so diagnosed, physicians are then obliged to give the patient the choice of two treatment options: surgical treatment or watch-and-wait without surgery. Radical surgical treatment is adopted as a rescue/salvage therapy if during the watch-and-wait period, local recurrence in patients occurs. In contrast, opponents of the strategy of watch-and-wait, purport that evidence for its efficacy is inadequate to justify routine use. Results. Literature data indicates that the rate of cCR depends on the tumour size, with incidence ranging between 5% and 78% of those patients irradiated prior to surgery. If the patients were kept under watch-and-wait without surgery, then the local recurrence rate was around 30%. Such high rates of local recurrences does not however disqualify this approach because the efficacy of rescue surgery was high. Distant metastases were rare, up 10% of patients, and survivals were even better compared to control patient groups who had been operated on due to not achieving cCR; this difference arising from the inherently less aggressive tumours that are sensitive to irradiation. Conclusions. The data hitherto indicate that a policy of watch-and-wait may be adopted in patients with CCR after chemoradiotherapy. Nevertheless, introducing this strategy requires acquiring experience for diagnosing CCR and an efficient organisation and supervision of treatment along with the rigorous follow-up. NOWOTWORY J Oncol 2017; 67, 2: 146-151

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Section: Correlation Between Ccr and Pcrsupporting

confidence: 59%

Section: Efficacy Of Rescue Surgerysupporting

confidence: 58%

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Rectal cancer patients can be treated conservatively

Bujko

2017

Nowotwory. Journal of Oncology

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“…A Danish group [29] evaluated distal T2-T3 tumors with high dose radiotherapy and oral tegafur-uracil. At 6 weeks, those with complete clinical regression, negative biopsies and no nodal or distal metastases on CT and MRI underwent a watchful waiting approach.…”

Section: Non-operative Management or Watch-and-waitmentioning

confidence: 99%

Complete Clinical Response in Rectal Adenocarcinoma: Review of Treatment Options

Scully¹,

C²,

Lee-Kong³

2017

J Clin Gastroenterol Hepatol

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The standard treatment for locally advanced rectal cancer is neoadjuvant chemoradiation followed by radical proctectomy with total mesorectal excision. A significant percentage of patients exhibit a pathological complete response with associated survival benefit. The management of patients who exhibit a complete clinical response after neoadjuvant chemoradiation, and could potentially avoid major resection, is a topic of great interest in colorectal surgery today. This paper reviews treatment options for this population.

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“…This last year has seen considerable progress in the field with the publication of several prospective studies (44,45) as well as a large retrospective series (46) (60,61). MRI is especially interesting as a modality for daily imaging for rectal cancer radiotherapy, as the primary tumour is challenging to visualize using on-board CT. MRI-guidance would allow for much more accurate daily delivery of dose-escalated treatments, but could potentially also be used for daily treatment adaptation.…”

Section: Technological Advances and Organ-preservation Strategiesmentioning

confidence: 99%

Technological advances in radiotherapy of rectal cancer: opportunities and challenges

Appelt

Sebag‐Montefiore

2016

Current Opinion in Oncology

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Purpose of review:This review summarizes the available evidence for the use of modern radiotherapy techniques for chemoradiotherapy (CRT) for rectal cancer, with specific focus on intensity-modulated radiotherapy (IMRT) and volumetric arc therapy (VMAT) techniques. Recent findings:The dosimetric benefits of IMRT and VMAT are well-established, but prospective clinical studies are limited, with phase I-II studies only. Recent years have seen the publication of a few larger prospective patient series as well as some retrospective cohorts, several of which include much needed late toxicity data. Overall results are encouraging, as toxicity levels although varying across reports appear lower than for 3D conformal radiotherapy. Innovative treatment techniques and strategies which may be facilitated by the use of IMRT/VMAT include simultaneously integrated tumour boost, adaptive treatment, selective sparing of specific organs to enable chemotherapy escalation, and non-surgical management. Summary:Few prospective studies of IMRT and VMAT exist, which causes uncertainty not just in regards to the clinical benefit of these technologies but also in the optimal use. The priority for future research should be subgroups of patients who might receive relatively greater benefit from innovative treatment techniques, such as patients receiving CRT with definitive intent and patients treated with dose escalation.

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High-dose chemoradiotherapy and watchful waiting for distal rectal cancer: a prospective observational study

Cited by 484 publications

References 28 publications

Rectal cancer patients can be treated conservatively

Rectal cancer patients can be treated conservatively

Complete Clinical Response in Rectal Adenocarcinoma: Review of Treatment Options

Technological advances in radiotherapy of rectal cancer: opportunities and challenges

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