"Watch and wait" approach in rectal cancer patients following complete clinical response to neoadjuvant chemoradiotherapy does not compromise oncologic outcomes.
Journal
The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology
ISSN: 2148-5607
Titre abrégé: Turk J Gastroenterol
Pays: Turkey
ID NLM: 9515841
Informations de publication
Date de publication:
Nov 2019
Nov 2019
Historique:
entrez:
27
11
2019
pubmed:
27
11
2019
medline:
30
5
2020
Statut:
ppublish
Résumé
Although standart treatment for non-metastatic locally advanced rectal cancer includes neoadjuvant chemoradiation followed by surgical resection, patients who have achieved complete clinical response can be followed up without surgery. Between 2010 and 2016, 61 patients received neoadjuvant chemoradiotherapy for low rectal cancer. Those patients who achieved clinical complete response were included in the "watch and wait" protocol and did not receive surgery. The remaining patients underwent radical surgery and some of these were diagnosed as having complete response pathologically. This study compared the oncological results of clinically complete responders with those patients defined as pathologically tumor-free. Seven patients who received neoadjuvant chemoradiotherapy were re-staged as having complete clinical response and included in the "watch and wait" approach protocol. The 5-year disease free survival was 100%. Mean follow-up was 63 months and the mean age was 57.3. Fifty-four patients underwent radical surgery and 7 of them were diagnosed as having pathological complete response. The 5-year survival was 100%. Mean follow-up was 56 months and the mean age was 50.6. All patients except one are alive without tumor recurrence in the surgery group. However, those who received surgery experienced significant morbidities due to their surgery. The oncological results of the "watch and wait" approach patients were no different from the patients who received radical surgery and were diagnosed as having pathological complete response. Those patients in particular who required abdomino-perineal resection before chemoradiation should be informed about this approach if they have achieved complete response clinically.
Sections du résumé
BACKGROUND/AIMS
OBJECTIVE
Although standart treatment for non-metastatic locally advanced rectal cancer includes neoadjuvant chemoradiation followed by surgical resection, patients who have achieved complete clinical response can be followed up without surgery.
MATERIALS AND METHODS
METHODS
Between 2010 and 2016, 61 patients received neoadjuvant chemoradiotherapy for low rectal cancer. Those patients who achieved clinical complete response were included in the "watch and wait" protocol and did not receive surgery. The remaining patients underwent radical surgery and some of these were diagnosed as having complete response pathologically. This study compared the oncological results of clinically complete responders with those patients defined as pathologically tumor-free.
RESULTS
RESULTS
Seven patients who received neoadjuvant chemoradiotherapy were re-staged as having complete clinical response and included in the "watch and wait" approach protocol. The 5-year disease free survival was 100%. Mean follow-up was 63 months and the mean age was 57.3. Fifty-four patients underwent radical surgery and 7 of them were diagnosed as having pathological complete response. The 5-year survival was 100%. Mean follow-up was 56 months and the mean age was 50.6. All patients except one are alive without tumor recurrence in the surgery group. However, those who received surgery experienced significant morbidities due to their surgery.
CONCLUSION
CONCLUSIONS
The oncological results of the "watch and wait" approach patients were no different from the patients who received radical surgery and were diagnosed as having pathological complete response. Those patients in particular who required abdomino-perineal resection before chemoradiation should be informed about this approach if they have achieved complete response clinically.
Identifiants
pubmed: 31767549
doi: 10.5152/tjg.2019.18984
pmc: PMC6883993
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
951-956Références
Ulus Cerrahi Derg. 2014 Dec 01;30(4):219-21
pubmed: 25931933
Int J Radiat Oncol Biol Phys. 2014 Mar 15;88(4):822-8
pubmed: 24495589
Am J Gastroenterol. 2004 Jan;99(1):109-12
pubmed: 14687151
Eur J Surg Oncol. 2018 Jan;44(1):93-99
pubmed: 29217398
Radiology. 2013 Oct;269(1):101-12
pubmed: 23801777
Ann Surg Oncol. 2009 Feb;16(2):254-65
pubmed: 19018597
Ann Surg. 2018 Dec;268(6):955-967
pubmed: 29746338
Int J Cancer. 2012 Dec 1;131(11):2604-11
pubmed: 22447461
J Clin Oncol. 2012 Jun 1;30(16):1926-33
pubmed: 22529255
J Gastrointest Surg. 2006 Dec;10(10):1319-28; discussion 1328-9
pubmed: 17175450
N Engl J Med. 2004 Oct 21;351(17):1731-40
pubmed: 15496622
Dis Colon Rectum. 2010 Dec;53(12):1692-8
pubmed: 21178866
Ann Surg. 2011 Apr;253(4):711-9
pubmed: 21475011
Ann Surg Oncol. 2012 Feb;19(2):384-91
pubmed: 21755378
Br J Surg. 2012 Jul;99(7):897-909
pubmed: 22539154
Colorectal Dis. 2014 Oct;16(10):O339-46
pubmed: 24916286
Surg Oncol Clin N Am. 2014 Jan;23(1):113-25
pubmed: 24267169
Hematol Oncol Clin North Am. 2015 Feb;29(1):135-51
pubmed: 25475576
Br J Surg. 2018 Oct;105(11):1510-1518
pubmed: 29846017
Ann Surg. 2004 Oct;240(4):711-7; discussion 717-8
pubmed: 15383798
Lancet Oncol. 2010 Sep;11(9):835-44
pubmed: 20692872
Dis Colon Rectum. 2018 Oct;61(10):1146-1155
pubmed: 30192323
Dis Colon Rectum. 2017 Mar;60(3):335-345
pubmed: 28177997
Dis Colon Rectum. 2013 Oct;56(10):1109-17
pubmed: 24022527
Ann Surg Oncol. 2010 Feb;17(2):441-7
pubmed: 19847569
Int J Colorectal Dis. 2016 Feb;31(2):413-9
pubmed: 26607907