Preoperative radiotherapy and local excision of rectal cancer with immediate radical re-operation for poor responders: A prospective multicentre study

Bujko, Krzysztof; Richter, Piotr; Smith, F. H.; Polkowski, Wojciech; Szczepkowski, Marek; Rutkowski, A.; Dziki, Adam; Pietrzak, L.; Kołodziejczyk, M; Kuśnierz, Jerzy; Gach, Tomasz; Kulig, Jan; Nawrocki, G; Radziszewski, Jakub; Wierzbicki, Ryszard; Kowalska, Teresa; Meissner, Wiktor; Radkowski, A.; Paprota, Krzysztof; Polkowski, Marcin; Rychter, Anna

doi:10.1016/j.radonc.2012.12.005

Cited by 111 publications

(96 citation statements)

References 38 publications

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“…This has been shown by pathological studies on patients that underwent resection despite achieving cCR. 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: 60%

“…In a significant proportion of pCR cases, there is a persistent tumour or ulcer present [10][11][12][13][14]. Only microscopic examination shows that the tumour is not malignant, but is only composed of stromal fibrous tissue.…”

Section: Correlation Between Ccr and Pcrmentioning

confidence: 99%

“…Only microscopic examination shows that the tumour is not malignant, but is only composed of stromal fibrous tissue. Table I presents outcomes of prospective studies evaluating clinical and pathological rates of complete responses to preoperative chemoradiotherapy in relation to tumour size [10,11,13,14]. The smaller the tumour, the more often is pCR achieved after chemoradiotherapy and the more often does it coincide with cCR [10][11][12].…”

Section: Correlation Between Ccr and Pcrmentioning

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: 60%

Section: Correlation Between Ccr and Pcrmentioning

confidence: 99%

Section: Correlation Between Ccr and Pcrmentioning

confidence: 99%

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Rectal cancer patients can be treated conservatively

Bujko

2017

Nowotwory. Journal of Oncology

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“…Only one study has specifically addressed the role of SCRT with delayed LE [157]. Large prospective studies with long follow-up periods are needed to evaluate the risk of postoperative complications and understand the implications in terms of oncologic outcomes of both neoadjuvant SCRT and long-course radiotherapy followed by TEM.…”

Section: Expc: 909%]mentioning

confidence: 99%

Early rectal cancer: the European Association for Endoscopic Surgery (EAES) clinical consensus conference

et al. 2015

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“…The short-course radiotherapy is with acute toxicity included gastrointestinal symptoms or sacral pain occurred after 3-7 days after the completion of radiotherapy in about 10% of patients [9].…”

Section: Short-course Neoadjuvant Radiotherapymentioning

confidence: 99%