Watch-and-wait strategy in rectal cancer: Is there a tumour size limit? Results from two pooled prospective studies.

Aged Chemoradiotherapy Humans Neoadjuvant Therapy Neoplasm Recurrence, Local Prospective Studies Rectal Neoplasms / drug therapy Treatment Outcome Watchful Waiting

Preoperative radiotherapy Rectal cancer Watch-and-wait strategy

Journal

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology

ISSN: 1879-0887

Titre abrégé: Radiother Oncol

Pays: Ireland

ID NLM: 8407192

Informations de publication

Date de publication:
07 2021

Historique:

received: 24 03 2021

revised: 06 05 2021

accepted: 12 05 2021

pubmed: 24 5 2021

medline: 28 7 2021

entrez: 23 5 2021

Statut: ppublish

Résumé

Frequency and predictive factors for a clinical complete response (cCR) in unselected patients are unclear. Two prospective observational studies were designed and pooled to explore predictive factors for cCR. Both studies evaluated the watch-and-wait strategy in consecutive patients; the first single-institutional study in elderly with a small tumour, the second multi-institutional study in all the patients receiving standard of care preoperative radiotherapy. Four hundred and ninety patients were analysed. Short-course radiotherapy alone, or with consolidation chemotherapy or chemoradiation was given to 40.6%, 40.2% and 19.2% of the patients, respectively. The median interval from the radiation start to the first tumour response assessment was 10.2 weeks for short-course radiation and 13.2 weeks for chemoradiation. Seventy-three patients had cCR and 71 underwent w&w with the median follow-up of 24 months. The regrowth rate was 26.8%. cCR rate was 39.0% for low-risk cancer (cT1-2N0), 16.8% for intermediate-risk (cT3 with unthreatened mesorectal fascia [MRF-] or cT2N+) and 5.4% for high-risk (cT4 or MRF+). In the multivariable analysis, tumour volume (or tumour length and circumferential extent) and cN status were significant predictors for cCR. In circular cancers or with a length ≥7 cm (n = 184), cCR rate was only 2.7%, sustained cCR 1.6% and the sensitivity of cCR diagnosis 23.1%. None of 27 patients with a tumour larger than 120 cm Considering watch-and-wait strategy is questionable in patients with circular tumours or with tumour length ≥7 cm.

Sections du résumé

BACKGROUND

Frequency and predictive factors for a clinical complete response (cCR) in unselected patients are unclear.

MATERIAL AND METHODS

Two prospective observational studies were designed and pooled to explore predictive factors for cCR. Both studies evaluated the watch-and-wait strategy in consecutive patients; the first single-institutional study in elderly with a small tumour, the second multi-institutional study in all the patients receiving standard of care preoperative radiotherapy.

RESULTS

Four hundred and ninety patients were analysed. Short-course radiotherapy alone, or with consolidation chemotherapy or chemoradiation was given to 40.6%, 40.2% and 19.2% of the patients, respectively. The median interval from the radiation start to the first tumour response assessment was 10.2 weeks for short-course radiation and 13.2 weeks for chemoradiation. Seventy-three patients had cCR and 71 underwent w&w with the median follow-up of 24 months. The regrowth rate was 26.8%. cCR rate was 39.0% for low-risk cancer (cT1-2N0), 16.8% for intermediate-risk (cT3 with unthreatened mesorectal fascia [MRF-] or cT2N+) and 5.4% for high-risk (cT4 or MRF+). In the multivariable analysis, tumour volume (or tumour length and circumferential extent) and cN status were significant predictors for cCR. In circular cancers or with a length ≥7 cm (n = 184), cCR rate was only 2.7%, sustained cCR 1.6% and the sensitivity of cCR diagnosis 23.1%. None of 27 patients with a tumour larger than 120 cm

CONCLUSIONS

Considering watch-and-wait strategy is questionable in patients with circular tumours or with tumour length ≥7 cm.

Identifiants

DOI: 10.1016/j.radonc.2021.05.014 PMID: 34023328

pubmed: 34023328

pii: S0167-8140(21)06252-6

doi: 10.1016/j.radonc.2021.05.014

pii:

doi:

Types de publication

Journal Article Observational Study Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

Pagination

229-235

Informations de copyright

Déclaration de conflit d'intérêts

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.