Long-term outcomes of clinical complete responders after neoadjuvant treatment for rectal cancer in the International Watch &amp; Wait Database (IWWD): an international multicentre registry study

Valk, Maxime J M van der; Hilling, Denise E.; Bastiaannet, E.; Kranenbarg, Elma Meershoek-Klein; Beets, Geerard L.; Figueiredo, Nuno; Habr‐Gama, Angelita; Perez, Rodrigo Oliva; Renehan, Andrew G; Velde, Cornelis J.H. van de; Ahlberg, Madeleine; Appelt, Ane L; Asoğlu, Oktar; Bär, Maria-Theresa; Barroca, Rita; Beets‐Tan, Regina G. H.; Belgers, E.; Bosker, Robbert J. I.; Breukink, Stéphanie O.; Bujko, Krzysztof; Carvalho, Carlos; Cunningham, Christopher; Creavin, Ben; D’Hoore, André; Gérard, Jean-Pierre; Gollins, Simon; Hoff, Christiaan; Holman, Fabian A.; Hupkens, B.; Iseas, Soledad; Jakobsen, Anders; Keshvari, Amir; Koopal, Sietze A.; Kusters, Miranda; Langheinrich, Melanie; Leijtens, Jeroen W. A.; Maas, Monique; Malcomson, Lee; Маmedli, Z. Z.; Martling, Anna; Matzel, Klaus E.; Melenhorst, Jarno; Morici, Maria Laura; Murad-Regadas, Sthela M.; O’Dwyer, Sarah T; Peeters, Koen; Rosa, Isadora; Rossi, Gustavo; Rutten, H.J.T.; Loria, Fernando Sánchez; Sande, Marit E. van der; Julião, Guilherme P. São; Saunders, Mark; Myint, Arthur Sun; Sluis, Hedwig van der; Schiappa, Renaud; Scott, Nigel; Stoot, Jan H.M.B.; Talsma, A Koen; Terrasson, I; Tokmak, Handan; Vaccaro, Carlos; Vahrmeijer, Alexander L.; Wasowicz, D. K.; Westreenen, Henderik L. van; Winter, D. C.; Wolthuis, Albert; Zimmerman, D. D. E.

doi:10.1016/s0140-6736(18)31078-x

Cited by 768 publications

(701 citation statements)

References 30 publications

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“…Baseline sphincter function is another important factor since the benefit of an organ preservation treatment is very limited for patients who already present with fecal incontinence. Furthermore, patients need to be informed about the need of a regular surveillance if a cCR is achieved and the risk for local regrowth which is approximately 25% [13]. …”

Section: How To Select Patients For a “Watch And Wait” Strategy? And mentioning

confidence: 99%

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Watchful Waiting after Radiochemotherapy in Rectal Cancer: When Is It Feasible?

2019

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A “watch and wait” strategy in rectal cancer is increasingly considered in patients who achieve an excellent response to radiotherapy. While a growing number of studies have shown the feasibility of this strategy in selected patients, the optimal therapeutic regimen to maximize response rates still needs to be established. Furthermore, accurate response prediction and the management of minor residual findings after radiotherapy remain a matter of debate. Finally, concerns regarding the long-term oncological safety of the “watch and wait” approach have been expressed. Therefore, the present review aims to address the open questions in the context of a “watch and wait” strategy and focuses on the diagnosis of a clinical complete response and the ideal management thereafter.

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Section: How To Select Patients For a “Watch And Wait” Strategy? And mentioning

confidence: 99%

“…Approximately 25% of patients will develop local regrowth and the majority of these can be salvaged given a timely detection [10, 13, 17]. Endoscopy is the most relevant modality for surveillance since in most studies > 95% of local regrowths were seen in the rectal wall [18].…”

Section: What Is the Optimal Surveillance Strategy?mentioning

confidence: 99%

Watchful Waiting after Radiochemotherapy in Rectal Cancer: When Is It Feasible?

2019

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“…Our literature search (box 2) identified three meta-analyses of observational data, two of study-level data1516 and one of individual participant data17; a matched-controlled study18; and an international registry, including published and unpublished data19 (see table 1). We found no published randomised controlled trial.…”

Section: What Is the Evidence Of Uncertainty?mentioning

confidence: 99%

“…Most studies report on outcomes at two to three years, and longer term evidence is lacking. The International Watch and Wait Database (IWWD),19 the largest series of patients with rectal cancer managed by watch-and-wait (880 patients), noted that five-year overall survival was 85% (95% confidence interval 80.9% to 87.7%) and five-year disease-specific survival was 94% (91% to 96%).…”

Section: What Is the Evidence Of Uncertainty?mentioning

confidence: 99%

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Is “watch-and-wait” after chemoradiotherapy safe in patients with rectal cancer?

Smith

Cresswell

Myint

et al. 2018

BMJ

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Total Neoadjuvant Therapy vs Standard Therapy in Locally Advanced Rectal Cancer

et al. 2020

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Key Points Question Is total neoadjuvant therapy (TNT) associated with improved outcomes when compared with standard concurrent chemoradiotherapy followed by surgery and adjuvant chemotherapy (CRT plus A) for locally advanced rectal cancer? Findings In this systematic review and meta-analysis of 7 unique studies including 2416 unique patients, TNT was found to be associated with a significantly higher rate of achieving a pathologic complete response and disease-free survival compared with the standard CRT plus A approach. No significant difference was found in rates of sphincter-preserving surgery or ileostomy requirements between the 2 approaches. Meaning Total neoadjuvant therapy was associated with improved pathologic complete response rates and has a potential disease-free survival advantage compared with the standard CRT plus A strategy in locally advanced rectal cancer.

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Long-term outcomes of clinical complete responders after neoadjuvant treatment for rectal cancer in the International Watch & Wait Database (IWWD): an international multicentre registry study

Abstract: European Registration of Cancer Care financed by European Society of Surgical Oncology, Champalimaud Foundation Lisbon, Bas Mulder Award granted by the Alpe d'Huzes Foundation and Dutch Cancer Society, and European Research Council Advanced Grant.

Cited by 768 publications

References 30 publications

Watchful Waiting after Radiochemotherapy in Rectal Cancer: When Is It Feasible?

Watchful Waiting after Radiochemotherapy in Rectal Cancer: When Is It Feasible?

Is “watch-and-wait” after chemoradiotherapy safe in patients with rectal cancer?

Total Neoadjuvant Therapy vs Standard Therapy in Locally Advanced Rectal Cancer

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