Wait-and-see policy for clinical complete responders after chemoradiation for rectal cancer
- PMID:22067400
- DOI: 10.1200/JCO.2011.37.7176
Wait-and-see policy for clinical complete responders after chemoradiation for rectal cancer
Abstract
Purpose: Neoadjuvant chemoradiotherapy for rectal cancer can result in complete disappearance of tumor and involved nodes. In patients without residual tumor on imaging and endoscopy (clinical complete response [cCR]) a wait-and-see-policy (omission of surgery with follow-up) might be considered instead of surgery. The purpose of this prospective cohort study was to evaluate feasibility and safety of a wait-and-see policy with strict selection criteria and follow-up.
Patients and methods: Patients with a cCR after chemoradiotherapy were prospectively selected for the wait-and-see policy with magnetic resonance imaging (MRI) and endoscopy plus biopsies. Follow-up was performed 3 to 6 monthly and consisted of MRI, endoscopy, and computed tomography scans. A control group of patients with a pathologic complete response (pCR) after surgery was identified from a prospective cohort study. Functional outcome was measured with the Memorial Sloan-Kettering Cancer Center (MSKCC) bowel function questionnaire and Wexner incontinence score. Long-term outcome was estimated by using Kaplan-Meier curves.
Results: Twenty-one patients with cCR were included in the wait-and-see policy group. Mean follow-up was 25 ± 19 months. One patient developed a local recurrence and had surgery as salvage treatment. The other 20 patients are alive without disease. The control group consisted of 20 patients with a pCR after surgery who had a mean follow-up of 35 ± 23 months. For these patients with a pCR, cumulative probabilities of 2-year disease-free survival and overall survival were 93% and 91%, respectively.
Conclusion: A wait-and-see policy with strict selection criteria, up-to-date imaging techniques, and follow-up is feasible and results in promising outcome at least as good as that of patients with a pCR after surgery. The proposed selection criteria and follow-up could form the basis for future randomized studies.
Trial registration: ClinicalTrials.govNCT00939666.
Comment in
- Minimizing therapy and maximizing outcomes in rectal cancer.Tepper JE, O'Neil BH.Tepper JE, et al.J Clin Oncol. 2011 Dec 10;29(35):4604-6. doi: 10.1200/JCO.2011.38.1335. Epub 2011 Nov 7.J Clin Oncol. 2011.PMID:22067395No abstract available.
- Watch and wait after neoadjuvant therapy for rectal cancer.Dattani M, Moran BJ.Dattani M, et al.Br J Surg. 2016 May;103(6):629-631. doi: 10.1002/bjs.10172. Epub 2016 Mar 17.Br J Surg. 2016.PMID:26991060No abstract available.
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