A single‐centre experience of chemoradiotherapy for rectal cancer: is there potential for nonoperative management?

Dalton, Richard; Velineni, Rahul; Osborne, M.; Thomas, R. S.; Harries, S.R.; Gee, Andrew; Daniels, Ian R.

doi:10.1111/j.1463-1318.2011.02752.x

Cited by 142 publications

(120 citation statements)

References 23 publications

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“…All reports indicate that distant metastases in cCR patients are rare, being at a maximum of 10% patients. Outcomes from other studies are presented in Table II [23][24][25][26][27]. In several of these, the decision not to treat metastases in regional lymph nodes (cN+) was not a contraindication for watch-and-wait [6,9,18].…”

Section: Long-term Results In Ccr Patients Undergoing Watch-and-waitmentioning

confidence: 99%

Rectal cancer patients can be treated conservatively

Bujko

2017

Nowotwory. Journal of Oncology

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Introduction. The strategy of undertaking a watch-and-wait policy without surgical treatment is currently being debated in those patients where complete clinical response/regression (cCR) has been diagnosed after preoperative irradiation. Its proponents maintain that there is sufficient evidence of efficacy allowing routine use. This means that following preoperative chemoradiotherapy, each patient should be investigated for cCR. If so diagnosed, physicians are then obliged to give the patient the choice of two treatment options: surgical treatment or watch-and-wait without surgery. Radical surgical treatment is adopted as a rescue/salvage therapy if during the watch-and-wait period, local recurrence in patients occurs. In contrast, opponents of the strategy of watch-and-wait, purport that evidence for its efficacy is inadequate to justify routine use. Results. Literature data indicates that the rate of cCR depends on the tumour size, with incidence ranging between 5% and 78% of those patients irradiated prior to surgery. If the patients were kept under watch-and-wait without surgery, then the local recurrence rate was around 30%. Such high rates of local recurrences does not however disqualify this approach because the efficacy of rescue surgery was high. Distant metastases were rare, up 10% of patients, and survivals were even better compared to control patient groups who had been operated on due to not achieving cCR; this difference arising from the inherently less aggressive tumours that are sensitive to irradiation. Conclusions. The data hitherto indicate that a policy of watch-and-wait may be adopted in patients with CCR after chemoradiotherapy. Nevertheless, introducing this strategy requires acquiring experience for diagnosing CCR and an efficient organisation and supervision of treatment along with the rigorous follow-up. NOWOTWORY J Oncol 2017; 67, 2: 146-151

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Section: Long-term Results In Ccr Patients Undergoing Watch-and-waitmentioning

confidence: 99%

Rectal cancer patients can be treated conservatively

Bujko

2017

Nowotwory. Journal of Oncology

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“…Hay autores que han encontrado en sus series resultados similares y consideran viable la estrategia de observación, en casos seleccionados [31][32][33][34]61 . Aunque, el porcentaje reportado de respuesta clínica completa posterior a la neoadyuvancia es del 15 al 30 % 22 , ese valor no fue posible de determinar en nuestra serie.…”

Section: Discussionunclassified

Desenlaces del manejo no quirúrgico posterior a neoadyuvancia del cáncer localmente avanzado de recto

Torres-Mesa

Oliveros

Mesa

et al. 2014

Revista Colombiana de Cancerología

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“…Based on this, they advocate a selective wait and watch approach for the patients with complete clinical response to neoadjuvant chemoradiotherapy [39]. Whilst Habr-Gama and colleagues have experienced very encouraging results, other series have not shown such high complete response rates and therefore until more evidence is available caution must be adopted in the widespread adoption of this technique [40][41][42].…”

Section: The Role Of Preoperative Neoadjuvant Therapymentioning

confidence: 99%

Paradigm Shift in the Management of Rectal Cancer

Rawat

Evans

2014

Indian J Surg

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Surgery for rectal cancer in the pre-Total Mesorectal Excision (TME) era was associated with high local recurrence rates. The widespread adoption of the TME technique together with the addition of neoadjuvant oncological therapies have reduced local failure rates and improved survival for patients with rectal cancer. Advances in our knowledge, better understanding of tumour biology and refinement in minimal access techniques and equipment have significantly changed the management of rectal cancer. This paper reviews these changes and proposes a paradigm shift in how rectal cancer management is conceptualised and treated, such that the treatment of rectal cancer is separated into early tumours (potentially suitable for local excison), TME tumours (optimally managed by TME) and beyond TME tumours (optimally managed by multivisceral resection outside the TME plane).

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A single‐centre experience of chemoradiotherapy for rectal cancer: is there potential for nonoperative management?

Abstract: In this consecutive series of patients with locally advanced rectal cancer treated with CRT, 12% demonstrated a CCR and have been actively managed conservatively, thereby avoiding surgery. With further improvements in diagnostic assessment of response to CRT, this figure may rise.

Cited by 142 publications

References 23 publications

Rectal cancer patients can be treated conservatively

Rectal cancer patients can be treated conservatively

Desenlaces del manejo no quirúrgico posterior a neoadyuvancia del cáncer localmente avanzado de recto

Paradigm Shift in the Management of Rectal Cancer

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