Patterns of Failure and Survival for Nonoperative Treatment of Stage c0 Distal Rectal Cancer Following Neoadjuvant Chemoradiation Therapy

Habr‐Gama, Angelita; Perez, Rodrigo Oliva; Proscurshim, Igor; Campos, Fábio Angioluci Diniz; Nadalin, Wladimir; Kiss, Desidério Roberto; Gama-Rodrigues, Joaquim

doi:10.1016/j.gassur.2006.09.005

Cited by 353 publications

(236 citation statements)

References 36 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: 72%

“…All other studies were observational. The pioneer for propounding the watch-and-wait policy is Habr-Gama's team from Brazil [5,18,[20][21][22]. In those patients where achieving cCR is uncertain, then a full-thickness local excision of the tumour is performed.…”

Section: Long-term Results In Ccr Patients Undergoing Watch-and-waitmentioning

confidence: 99%

“…Outcomes from other studies are presented in Table II [23][24][25][26][27]. In several of these, the decision not to treat metastases in regional lymph nodes (cN+) was not a contraindication for watch-and-wait [6,9,18]. It has not been shown that treatment outcomes in this subgroup were any worse than patients diagnosed as cN0 before treatment.…”

Section: Long-term Results In Ccr Patients Undergoing Watch-and-waitmentioning

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 Pcrmentioning

confidence: 72%

Section: Long-term Results In Ccr Patients Undergoing Watch-and-waitmentioning

confidence: 99%

Section: Long-term Results In Ccr Patients Undergoing Watch-and-waitmentioning

confidence: 99%

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Rectal cancer patients can be treated conservatively

Bujko

2017

Nowotwory. Journal of Oncology

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“…Это может быть выявлено при видеоректоскопии и пред-ставляет собой «площадку» размером до 0,5 см белого цвета, не всегда определяемую при пальцевом ректаль-ном исследовании. Наличие язвенного дефекта и/или экзофитного компонента должно классифици-роваться как неполный клинический ответ [12].…”

Section: Discussionunclassified

Organ Saving Treatment of Rectal Cancer

Расулов¹,

Мамедли²,

Кузьмичев³

et al. 2016

Onkol. koloproktol.

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“…Habr-Gama, fue la primera cirujano en determinar prospectivamente, el manejo no quirúrgico de pacientes con cáncer localmente avanzado de recto, después de determinarse respuesta clínica completa posterior a la neoadyuvancia 19,[23][24][35][36][37][38][39] .…”

Section: Discussionunclassified