Organ Preservation in Rectal Cancer After Chemoradiation: Should We Extend the Observation Period in Patients with a Clinical Near-Complete Response?

Britt J. P. Hupkens, Monique Maas*, Milou H. Martens, Marit E. van der Sande, Doenja M. J. Lambregts, Stephanie O. Breukink, Jarno Melenhorst, Janneke B. Houwers, Christiaan Hoff, Meindert N. Sosef, Jeroen W. A. Leijtens, Maaike Berbee, Regina G. H. Beets-Tan, Geerard L. Beets

*Corresponding author for this work

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Abstract

To assess whether extending the observation period in patients with a near clinical complete response (near cCR) after chemoradiation (CRT) leads to an impaired oncological outcome. Patients who had a clinical complete response (cCR) 8-10 weeks after CRT restaging with magnetic resonance imaging and endoscopy were offered a watch-and-wait strategy (W&W1), while patients with a near cCR were offered to undergo local excision or a second restaging 6-12 weeks later. Patients who achieved a cCR at the second restaging were also offered a watch-and-wait strategy (W&W2). Overall, 102 patients with a cCR at the first restaging immediately entered the W&W1, while the remaining 68 patients had a near cCR: 19 patients underwent transanal endoscopic microsurgery and 49 patients opted for a second restaging. Additionally, 44/49 (90%) patients showed a cCR at the second restaging and entered the W&W2. Patients in the W&W1 group had a 2-year local regrowth-free rate (LRFR) of 84% and 2-year overall survival (OS) of 99%, while patients in the W&W2 group had a 2-year LRFR of 73% and OS of 98% (p > 0.05). Multivariable Cox regression analyses showed that late inclusion was not a significant predictive factor for higher risk of LR or lower non-regrowth disease-free survival. Overall, 90% of patients with a near cCR 8-10 weeks after CRT will proceed to a cCR 6-12 weeks later; therefore, it seems logical to extend the observation period rather than to proceed to surgery. Although there is a non-significant increase in local regrowth rate in these patients, it does not seem to impact the oncological outcome.
Original languageEnglish
Pages (from-to)197-203
Number of pages7
JournalAnnals of Surgical Oncology
Volume25
Issue number1
DOIs
Publication statusPublished - 1 Jan 2018

Keywords

  • TRANSANAL ENDOSCOPIC MICROSURGERY
  • PATHOLOGICAL COMPLETE RESPONSE
  • NEOADJUVANT CHEMORADIOTHERAPY
  • LOCAL EXCISION
  • SEE POLICY
  • THERAPY
  • SURGERY
  • WAIT
  • CHEMOTHERAPY
  • RADIOTHERAPY

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