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

Smith, Fraser Mc Lean; Cresswell, Katharine; Myint, Arthur Sun; Renehan, Andrew G

doi:10.1136/bmj.k4472

Cited by 17 publications

(12 citation statements)

References 20 publications

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“…In the OnCoRe project[ 104 ], 88% of patients with non-metastatic local regrowths were salvaged, a slightly higher rate than reported by Kong et al[ 162 ] (83.8%) and Smith et al[ 163 ] (85%), and well above the 68.4% rate described by On et al[ 164 ] and the 69% rate reported in the International Watch and Wait Database[ 107 ]. Moreover, the salvage rate in the OnCoRe study were close to those described by Chadi et al[ 165 ] (89%) and by the Habr-Gama group (90%)[ 161 ] (Table 2 ).…”

Section: Outcomes and Management Of Tumour Regrowthmentioning

confidence: 91%

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Watch and wait approach in rectal cancer: Current controversies and future directions

López-Campos¹,

Martín²,

Pérez³

et al. 2020

WJG

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According to the main international clinical guidelines, the recommended treatment for locally-advanced rectal cancer is neoadjuvant chemoradiotherapy followed by surgery. However, doubts have been raised about the appropriate definition of clinical complete response (cCR) after neoadjuvant therapy and the role of surgery in patients who achieve a cCR. Surgical resection is associated with significant morbidity and decreased quality of life (QoL), which is especially relevant given the favourable prognosis in this patient subset. Accordingly, there has been a growing interest in alternative approaches with less morbidity, including the organ-preserving watch and wait strategy, in which surgery is omitted in patients who have achieved a cCR. These patients are managed with a specific follow-up protocol to ensure adequate cancer control, including the early identification of recurrent disease. However, there are several open questions about this strategy, including patient selection, the clinical and radiological criteria to accurately determine cCR, the duration of neoadjuvant treatment, the role of dose intensification (chemotherapy and/or radiotherapy), optimal follow-up protocols, and the future perspectives of this approach. In the present review, we summarize the available evidence on the watch and wait strategy in this clinical scenario, including ongoing clinical trials, QoL in these patients, and the controversies surrounding this treatment approach.

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Section: Outcomes and Management Of Tumour Regrowthmentioning

confidence: 91%

“…According to Smith et al[ 163 ], treatment outcomes (OS and DFS) in patients who undergo salvage surgery are comparable to those achieved in patients who undergo conventional surgery. That said, most of the reported survival outcomes are based on only 3 years of follow-up.…”

Section: Outcomes and Management Of Tumour Regrowthmentioning

confidence: 99%

Watch and wait approach in rectal cancer: Current controversies and future directions

López-Campos¹,

Martín²,

Pérez³

et al. 2020

WJG

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“…Colorectal cancer (CRC) is the third most commonly diagnosed malignancy and second leading cause of cancer death globally 1 . Radical resection is still the most effective treatment for patients with colon cancer 2 . However, colon cancer prognosis remains poor because of its distant metastasis and local recurrence 3 .…”

Section: Introductionmentioning

confidence: 99%

Circular RNA circCTNNA1 promotes colorectal cancer progression by sponging miR-149-5p and regulating FOXM1 expression

et al. 2020

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Circular RNAs (circRNAs) are an emerging class of non-coding RNAs, identified to participate in multiple malignancies. Nevertheless, the clinical significance, biological function, and regulatory mechanisms of circRNAs in colon cancer (CC) remain largely unclear. In this study, the circRNA expression profile in CC and matched normal tissues was analyzed using circRNA microarrays. A novel circRNA, circCTNNA1, was significantly upregulated in CC, and its level was associated with advanced tumor–node–metastasis stage and poor prognosis of patients with CC. Functional experiments, including Cell Counting Kit-8, colony formation, 5‐ethynyl‐2′‐deoxyuridine, transwell, wound healing, flow cytometric analysis, and in vivo tumorigenesis assay were then performed to investigate the oncogenic role of circCTNNA1. The results revealed that circCTNNA1 promoted CC cell proliferation, migration, and invasion in vitro and in vivo. Mechanistically, RNA pull-down, RNA immunoprecipitation, dual-luciferase reporter assays, and fluorescent in situ hybridization were performed to unveil that circCTNNA1 can serve as a competing endogenous RNA of miR-149-5p to counteract the suppressive effect of miR-149-5p on downstream target Forkhead Box M1 (FOXM1). In summary, our study demonstrated that circCTNNA1 facilitated CC proliferation and invasion via the circCTNNA1/miR-149-5p/FOXM1 axis, and it might function as a novel diagnostic or therapeutic target for patients with CC.

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“…The current trend of evidence-based medicine is defined as an approach to medical practice intended to optimize decision-making by emphasizing the use of evidence from welldesigned and well-conducted research obliges the clinician to pay increased attention to the design of the study so he can safely apply the results in his practice. Keeping this in mind, as of November 2018, there were no published prospective randomized trials on this subject (20).…”

Section: Discussionmentioning

confidence: 99%

Watch and Wait Strategy for Rectal Cancer: 15 Years After the First Published Study. Are We any Closer to the Non-operative Management of Rectal Cancer?

Tulin¹,

Nițipir²,

Slavu³

et al. 2019

chr

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Introducere: De-a lungul timpului, tratamentul cancerului rectal a evoluat semnificativ prin utilizarea sporită a radiochimoterapiei neoadjuvante. Material şi metoda: Ghidul P.I.C.O.S a fost utilizat pentru a structura întrebările şi topica cercetării în vederea obţinerii validităţii clinice. Rezultatele obţinute au fost filtrate conform ghidului PRISMA. Rezultate: Am identificat un număr de 42 de lucrări, după screeningul acestora, au rămas 27 pentru a completa cercetarea. Discuţii: Există un interes crescut faţă de managementul neoperator al cancerului rectal întrucât până la 25% dintre pacienţii supuşi unui regim de radiochimioterapie preoperatorie au demonstrat răspuns patologic complet (absenţa celulelor tumorale pe specimenele rezecate). Aceste informaţii conduc la ideea atrăgătoare că, în unele cazuri, intervenţia chirurgicală poate fi evitată. Din nefericire, există o lipsă de date de calitate pentru a susţine această nouă tendinţă. Datorită interesului recent crescut a fost creată o bază de date internaţională în care pacienţii aflaţi în perioada de w&w pot fi înscrişi şi monitorizaţi. Până în prezent, baza de date conţine peste 900 de pacienţi. De asemenea, sunt în curs de finalizare studii prospective de calitate. Concluzii: Cu toate aceste eforturi recente, utilizarea pe scară largă Abstract Introduction: Over time, the management of rectal cancer has undoubtedly evolved with the use of neoadjuvant radiochemotherapy. Material and method: The P.I.C.O.S guidelines were used to structure the questions and the research topic as to attain clinical validity. The results of the research were filtered in accordance with the PRISMA checklist. Results: We identified 42 papers. After screening 27 papers were used to complete the analysis. Discussion: There is an increased interest towards the non-operative management of rectal cancer, as up to 25% of patients with preoperative radiochemotherapy have demonstrated complete pathological response (absence of tumor cells on the operative specimens). This information leads to the tantalizing idea that in some cases, surgery can be avoided. Unfortunately, there is a lack of quality data to support this view. Due to increased interest in this subject, an international database in which patients with w&w therapy can be enrolled and monitored. Up to now, the database contains over 900 patients. Also, quality prospective trials are emerging. Conclusion: Even with all these recent efforts, the wide-use of this therapy is precluded due to the absence of a standardized evaluation of these patients in the follow-up period.

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

Cited by 17 publications

References 20 publications

Watch and wait approach in rectal cancer: Current controversies and future directions

Watch and wait approach in rectal cancer: Current controversies and future directions

Circular RNA circCTNNA1 promotes colorectal cancer progression by sponging miR-149-5p and regulating FOXM1 expression

Watch and Wait Strategy for Rectal Cancer: 15 Years After the First Published Study. Are We any Closer to the Non-operative Management of Rectal Cancer?

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