Clinical Complete Response in Patients With Rectal Adenocarcinoma Treated With Short-Course Radiation Therapy and Nonoperative Management

Chin, R; Roy, Amit; Pedersen, Katrina; Huang, Yi; Hunt, Steven R.; Glasgow, Sean C.; Tan, Benjamin; Wise, Paul E.; Silviera, Matthew L.; Smith, Radhika; Suresh, Rama; Badiyan, Shahed N.; Shetty, Anup S.; Henke, Lauren E.; Mutch, Matthew G.; Kim, Hyun

doi:10.1016/j.ijrobp.2021.10.004

Cited by 29 publications

(32 citation statements)

References 49 publications

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“…Data on NOM following SCRT and consolidation chemotherapy are sparse. Investigators from Washington University reported promising outcomes, with a 2-year FFLF rate of 81% in patients managed with NOM and a 2-year DFS rate of 98% after CR, which is comparable to our experience (2-y FFLF rate of 71.3% and 2-y DFS rate of 89.4%) 19,20. In addition, salvage of locally recurrent tumors was feasible in both cohorts.…”

Section: Discussionsupporting

confidence: 81%

“…Investigators from Washington University reported promising outcomes, with a 2-year FFLF rate of 81% in patients managed with NOM and a 2-year DFS rate of 98% after CR, which is comparable to our experience (2-y FFLF rate of 71.3% and 2-y DFS rate of 89.4%). 19,20 In addition, salvage of locally recurrent tumors was feasible in both cohorts. Taken together, our study and those by the Washington University investigators suggest that NOM after SCRT is feasible in locally advanced disease after achieving CR.…”

Section: Discussionmentioning

confidence: 99%

“…18 However, the majority of NOM studies include patients treated with LC-CRT with the exception of recent single institution data on SCRT. 19,20 Therefore, little is known regarding clinical outcomes of patients treated with SCRT and consolidation chemotherapy and managed with NOM in those patients with CR. In addition, it is unknown how hypofractionated radiation may impact bowel/rectal quality of life (QOL) in the NOM context.…”

mentioning

confidence: 99%

“…In fact, 5-year disease-specific survival rates up to 94% have been reported in patients treated with NOM 18. However, the majority of NOM studies include patients treated with LC-CRT with the exception of recent single institution data on SCRT 19,20. Therefore, little is known regarding clinical outcomes of patients treated with SCRT and consolidation chemotherapy and managed with NOM in those patients with CR.…”

mentioning

confidence: 99%

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Nonoperative Management Following Complete Response in Rectal Cancer After Short-course Radiation Therapy and Consolidation Chemotherapy

Reddy

Safar²,

Jia

et al. 2022

American Journal of Clinical Oncology

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Purpose: The purpose of his study was to report on a cohort of patients managed with nonoperative management (NOM) with a watch-and-wait strategy after achieving complete response (CR) to sequential short-course radiation therapy (SCRT) and consolidation chemotherapy.Methods: This was a retrospective study of patients treated SCRT and chemotherapy who achieved a CR and were managed with NOM. Bowel function was assessed with European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30, EORTC Quality of Life Questionnaire-Colorectal Cancer 29, and the low anterior resection syndrome (LARS) questionnaires. Endpoints included overall survival (OS), freedom from local failure (FFLF), freedom from distant metastasis, and disease-free survival (DFS).Results: Twenty-six patients met inclusion criteria. Seven (26.9%) patients developed local failure at a median of 6.8 months following CR, of which 5 were successfully salvaged. Median FFLF was not reached, with 6-month, 1-, and 2-year FFLF rates of 100.0%, 82.3%, and 71.3%. Median OS was not reached, with 6-month, 1-, and 2-year OS rates of 100%. Median DFS was not reached, with 6-month, 1-, and 2-year DFS rates of 100%, 95.0%, and 89.4%. Questionnaire response rate was 83.3%. Median LARS score was 27. Major, minor, and no LARS occurred in 3 (20%), 6 (40%), and 6 (40%) patients, respectively. There were no differences in questionnaire scores between patients who had the majority of their anal sphincter complex irradiated and those who did not. Conclusion:NOM with a watch-and-wait strategy is safe and feasible in patients with locally advanced rectal cancer who achieve CR after sequential SCRT and chemotherapy, with evidence for good anorectal function.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Nonoperative Management Following Complete Response in Rectal Cancer After Short-course Radiation Therapy and Consolidation Chemotherapy

Reddy

Safar²,

Jia

et al. 2022

American Journal of Clinical Oncology

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“…However, due to the shorter time interval between RT and surgery, SCRT has been historically associated with lower rates of tumor response. Nonetheless, recent studies utilizing TNT with consolidation chemotherapy-thus allowing for longer time from SCRT to surgery-have shown good response rates [17,18]; however, direct, randomized data comparing the two RT regimens are currently not available [19].…”

Section: Overview Of Neoadjuvant Therapymentioning

confidence: 99%

Non-Operative Management of Patients with Rectal Cancer: Lessons Learnt from the OPRA Trial

Goffredo

Quezada-Díaz

García-Aguilar

et al. 2022

Cancers

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Over the past decade, the management of locally advanced rectal cancer (LARC) has progressively become more complex. The introduction of total neoadjuvant treatment (TNT) has increased the rates of both clinical and pathological complete response, resulting in excellent long-term oncological outcomes. As a result, non-operative management (NOM) of LARC patients with a clinical complete response (cCR) after neoadjuvant therapy has gained acceptance as a potential treatment option in selected cases. NOM is based on replacement of surgical resection with safe and active surveillance. However, the identification of appropriate candidates for a NOM strategy without compromising oncologic safety is currently challenging due to the lack of an objective standardization. NOM should be part of the treatment plan discussion with LARC patients, considering the increasing rates of cCR, patient preference, quality of life, expectations, and the potential avoidance of surgical morbidity. The recently published OPRA trial showed that organ preservation is achievable in half of rectal cancer patients treated with TNT, and that chemoradiotherapy followed by consolidation chemotherapy may an appropriate strategy to maximize cCR rates. Ongoing trials are investigating optimal algorithms of TNT delivery to further expand the pool of patients who may benefit from NOM of LARC.

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Cost-effectiveness of Total Neoadjuvant Therapy With Short-Course Radiotherapy for Resectable Locally Advanced Rectal Cancer

et al. 2022

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IMPORTANCE Short-course radiotherapy and total neoadjuvant therapy (SCRT-TNT) followed by total mesorectal excision (TME) has emerged as a new treatment paradigm for patients with locally advanced rectal adenocarcinoma. However, the economic implication of this treatment strategy has not been compared with that of conventional long-course chemoradiotherapy (LCCRT) followed by TME with adjuvant chemotherapy. OBJECTIVE To perform a cost-effectiveness analysis of SCRT-TNT vs LCCRT in conjunction with TME for patients with locally advanced rectal cancer. DESIGN, SETTING, AND PARTICIPANTSA decision analytical model with a 5-year time horizon was constructed for patients with biopsy-proven, newly diagnosed, primary locally advanced rectal adenocarcinoma treated with SCRT-TNT or LCCRT. Markov modeling was used to model disease progression and patient survival after treatment in 3-month cycles. Data on probabilities and utilities were extracted from the literature. Costs were evaluated from the Medicare payer's perspective in 2020 US dollars. Sensitivity analyses were performed for key variables. Data were collected from

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Clinical Complete Response in Patients With Rectal Adenocarcinoma Treated With Short-Course Radiation Therapy and Nonoperative Management

Cited by 29 publications

References 49 publications

Nonoperative Management Following Complete Response in Rectal Cancer After Short-course Radiation Therapy and Consolidation Chemotherapy

Nonoperative Management Following Complete Response in Rectal Cancer After Short-course Radiation Therapy and Consolidation Chemotherapy

Non-Operative Management of Patients with Rectal Cancer: Lessons Learnt from the OPRA Trial

Cost-effectiveness of Total Neoadjuvant Therapy With Short-Course Radiotherapy for Resectable Locally Advanced Rectal Cancer

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