Nonoperative Management of Rectal Cancer With Complete Clinical Response After Neoadjuvant Therapy

Smith, James D.; Ruby, Jeannine A.; Goodman, Karyn A.; Saltz, Leonard B.; Guillem, José G.; Weiser, Martin R.; Temple, Larissa K.; Nash, Garrett M.; Paty, Philip B.

doi:10.1097/sla.0b013e3182759f1c

Cited by 345 publications

(225 citation statements)

References 26 publications

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“…Complete regression at the primary tumour was achieved in a similar proportion of patients without clinically diagnosed nodal metastases, like in patients with metastases [6,9,18]. Furthermore, there was a strong correlation between the radiosensitiveness of the primary tumour with the radiosensitiveness of the metastases to lymph nodes.…”

Section: Correlation Between Ccr and Pcrmentioning

confidence: 61%

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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 Pcrmentioning

confidence: 61%

“…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 Surgerymentioning

confidence: 64%

Rectal cancer patients can be treated conservatively

Bujko

2017

Nowotwory. Journal of Oncology

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“…This non-operative approach is under investigation at multiple sites worldwide [35][36][37]. In the UK, 129 patients with cCR were thus managed [37].…”

Section: No Surgerymentioning

confidence: 99%

“…The current indication for nCRT is LARC, although the argument has been made that patients with relatively low-risk LARCs, such as cT3N0 cancers or upper rectal cancers, do not need to undergo nCRT [4,40,41]. Clinical examinations, including endoscopic findings and digital rectal evaluations, and radiological studies, play major roles in such evaluation [35][36][37]42].…”

Section: Prediction Of Crt Responsementioning

confidence: 99%

Clinical utility of pretreatment prediction of chemoradiotherapy response in rectal cancer: a review

Yoo

Yeo

2017

EPMA Journal

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Approximately 20% of all patients with locally advanced rectal cancer experience pathologically complete responses following neoadjuvant chemoradiotherapy (CRT) and standard surgery. The utility of radical surgery for patients exhibiting good CRT responses has been challenged. Organsparing strategies for selected patients exhibiting complete clinical responses include local excision or no immediate surgery. The subjects of this tailored management are patients whose presenting disease corresponds to current indications of neoadjuvant CRT, and their post-CRT tumor response is assessed by clinical and radiological examinations. However, a model predictive of the CRT response, applied before any treatment commenced, would be valuable to facilitate such a personalized approach. This would increase organ preservation, particularly in patients for whom upfront CRT is not generally prescribed. Molecular biomarkers hold the greatest promise for development of a pretreatment predictive model of CRT response. A combination of clinicopathological, radiological, and molecular markers will be necessary to render the model robust. Molecular research will also contribute to the development of drugs that can overcome the radioresistance of rectal tumors. Current treatments for rectal cancer are based on the expected prognosis given the presenting disease extent. In the future, treatment schemes may be modified by including the predicted CRT response evaluated at presentation.

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“…Similarly, investigators form Memorial Sloan Kettering Cancer Center [27] compared outcomes of 32 patients with cCR treated non-operatively with a cohort that was found to have pCR after surgical resection. Lack of visible pathology on exam and endoscopy were the primary determinants of cCR, and older age, lower pretreatment stage and distal tumor location were associated with NOM.…”

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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Nonoperative Management of Rectal Cancer With Complete Clinical Response After Neoadjuvant Therapy

Cited by 345 publications

References 26 publications

Rectal cancer patients can be treated conservatively

Rectal cancer patients can be treated conservatively

Clinical utility of pretreatment prediction of chemoradiotherapy response in rectal cancer: a review

Complete Clinical Response in Rectal Adenocarcinoma: Review of Treatment Options

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