TY - JOUR
T1 - Organ Preservation in Rectal Cancer After Chemoradiation
T2 - Should We Extend the Observation Period in Patients with a Clinical Near-Complete Response?
AU - Hupkens, Britt J. P.
AU - Maas, Monique
AU - Martens, Milou H.
AU - van der Sande, Marit E.
AU - Lambregts, Doenja M. J.
AU - Breukink, Stephanie O.
AU - Melenhorst, Jarno
AU - Houwers, Janneke B.
AU - Hoff, Christiaan
AU - Sosef, Meindert N.
AU - Leijtens, Jeroen W. A.
AU - Berbee, Maaike
AU - Beets-Tan, Regina G. H.
AU - Beets, Geerard L.
PY - 2018/1/1
Y1 - 2018/1/1
N2 - 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.
AB - 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.
KW - TRANSANAL ENDOSCOPIC MICROSURGERY
KW - PATHOLOGICAL COMPLETE RESPONSE
KW - NEOADJUVANT CHEMORADIOTHERAPY
KW - LOCAL EXCISION
KW - SEE POLICY
KW - THERAPY
KW - SURGERY
KW - WAIT
KW - CHEMOTHERAPY
KW - RADIOTHERAPY
U2 - 10.1245/s10434-017-6213-8
DO - 10.1245/s10434-017-6213-8
M3 - Article
SN - 1068-9265
VL - 25
SP - 197
EP - 203
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
IS - 1
ER -