Rectal cancer with complete clinical response after neoadjuvant chemoradiotherapy, surgery, or “watch and wait”

Lai, Chin-Hu; Lai, Mei-Ju; Wu, Chang‐Chieh; Jao, Shu-Wen; Hsiao, Cheng–Wen

doi:10.1007/s00384-015-2460-y

Cited by 73 publications

(61 citation statements)

References 23 publications

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“…13–27 Eight studies reported data for an adequate control proctectomy group, but there was significant variation. Four used a post-surgical pathological complete response (pCR) group for comparison 14,16,25,26 , 2 used cCR tumors undergoing surgery, 19,20 1 used both, 22 and 1 used a surgical group matched for clinical stage (regardless of tumor response). 23 Outcome data for incomplete response, non-response, and local excision were excluded from comparisons as these were not regarded as adequate control group data.…”

Section: Resultsmentioning

confidence: 99%

“…In contrast, the use of consolidation or adjuvant chemotherapy was highly variable, ranging from frequent use, 18,25,26 to use only if staged as node positive prior to neoadjuvant treatment, 15,21 infrequent use, 14,20,23 and complete omission. 13,16,17,19,22 Consolidation or adjuvant chemotherapy, when used, was most commonly 5-FU based with the addition of Oxaliplatin in two studies. 21,25 …”

Section: Resultsmentioning

confidence: 99%

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Nonoperative Management or ‘Watch and Wait’ for Rectal Cancer with Complete Clinical Response After Neoadjuvant Chemoradiotherapy: A Critical Appraisal

et al. 2017

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Purpose There is increasing interest in non-operative management (NOM) for rectal cancer with complete clinical (cCR) response after neoadjuvant chemoradiation (nCRT). The aim of this review is to summarize the available data on NOM, with the intention of formulating standardised protocols on which to base future investigation. Methods Systematic review following PRISMA guidelines was conducted. A highly sensitive literature search identified all relevant studies published between Jan 2004 and Dec 2016. Data extraction and quality assessment was performed independently by two authors, and resolved by consensus with a third. Results In total, 15 studies met inclusion criteria including 920 patients, 575 (62.5%) who underwent NOM after cCR, and the rest forming a surgical control group. The weighted mean followup was 39.4 (12.7) months in the NOM group and 39.8 (5.1) months in the surgery group. The pooled re-growth rate in the NOM group was 21.3% at a mean of 15.6 (7.0) months. Surgical salvage was possible and undertaken in 93.2% of these patients. Overall survival in the NOM group was 91.7%, and disease free survival was 82.7%. For the comparison proctectomy group, pooled rates of local recurrence, overall survival and disease free survival were 8.4%, 92.4%, and 87.5%, respectively. Conclusion NOM may be a feasible option for surgically eligible rectal cancer patients with cCR after nCRT. Before such a strategy can be widely implemented, further prospective data is required with standardised definitions, diagnostic criteria, and management protocols, with an emphasis on shared patient-provider decision making and patient centered outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Nonoperative Management or ‘Watch and Wait’ for Rectal Cancer with Complete Clinical Response After Neoadjuvant Chemoradiotherapy: A Critical Appraisal

et al. 2017

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“…This has notably improved survival and made minimally-invasive treatments more feasible. Neo-adjuvant chemo radiotherapy (CRT), followed by total mesorectal excision (TME) and adjuvant chemotherapy, remains the gold standard in the treatment of locally advanced rectal cancer (LARC) (4). LARC generally refers to Stage III rectal cancer, and it represents 70% of the rectal cancers on presentation (5).…”

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confidence: 99%

KRAS Mutant Status May Be Associated with Distant Recurrence in Early-stage Rectal Cancer

Sideris

Moorhead

Díaz‐Cano

et al. 2017

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“…Results of other retrospective studies of the watch-and-wait approach from the US, 22 UK, 23 and Taiwan, 24 together with the Brazilian studies, [19][20][21] are summarised in Table 1. They are all single-centre studies and include a small number of patients.…”

Section: Retrospective Studiesmentioning

confidence: 99%

Watch-and-wait Approach for Clinical Complete Responders after Neoadjuvant Chemoradiotherapy for Rectal Cancer

Law¹

2017

Hong Kong J Radiol

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Neoadjuvant chemoradiotherapy followed by total mesorectal excision is the standard of care for locally advanced rectal cancer. The mean pathological complete response rate following neoadjuvant chemoradiotherapy has been reported to be 12% to 16%. In clinical complete responders after neoadjuvant chemoradiation, a non-operative, watch-and-wait approach is thus proposed to allow for organ preservation. This paper reviews key studies of the watch-and-wait approach following neoadjuvant chemoradiotherapy for rectal cancer to determine its oncological outcomes and safety.

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Rectal cancer with complete clinical response after neoadjuvant chemoradiotherapy, surgery, or “watch and wait”

Cited by 73 publications

References 23 publications

Nonoperative Management or ‘Watch and Wait’ for Rectal Cancer with Complete Clinical Response After Neoadjuvant Chemoradiotherapy: A Critical Appraisal

Nonoperative Management or ‘Watch and Wait’ for Rectal Cancer with Complete Clinical Response After Neoadjuvant Chemoradiotherapy: A Critical Appraisal

KRAS Mutant Status May Be Associated with Distant Recurrence in Early-stage Rectal Cancer

Watch-and-wait Approach for Clinical Complete Responders after Neoadjuvant Chemoradiotherapy for Rectal Cancer

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