Operative Versus Nonoperative Treatment for Stage 0 Distal Rectal Cancer Following Chemoradiation Therapy

Habr‐Gama, Angelita; Perez, Rodrigo Oliva; Nadalin, Wladimir; Sabbaga, Jorge; Ribeiro, Ulysses; Sousa, Afonso Henrique Silva e; Campos, Fábio Angioluci Diniz; Kiss, Desidério Roberto; Gama-Rodrigues, Joaquim

doi:10.1097/01.sla.0000141194.27992.32

Cited by 1,600 publications

(1,221 citation statements)

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“…Angelita Habr-Gama, a colorectal surgeon from Brazil, pioneered the wait-and-see or watch-and-wait approach for rectal cancer patients [29][30][31]. This policy, which is also called non-operative management or no immediate surgery, is indicated for selected patients who show a clinical complete response (cCR) post-nCRT.…”

Section: No Surgerymentioning

confidence: 99%

“…Habr-Gama et al conducted a series of studies in which patients with principally T3 or N1 mid/low rectal tumors, who exhibited post-nCRT cCR, underwent close surveillance only [30][31][32][33][34]. The latest report found that this non-operative approach afforded a 5-year rate of local recurrence "not amenable to salvage" as low as 6% [33,34].…”

Section: No Surgerymentioning

confidence: 99%

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Clinical utility of pretreatment prediction of chemoradiotherapy response in rectal cancer: a review

Yoo

Yeo

2017

EPMA Journal

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Approximately 20% of all patients with locally advanced rectal cancer experience pathologically complete responses following neoadjuvant chemoradiotherapy (CRT) and standard surgery. The utility of radical surgery for patients exhibiting good CRT responses has been challenged. Organsparing strategies for selected patients exhibiting complete clinical responses include local excision or no immediate surgery. The subjects of this tailored management are patients whose presenting disease corresponds to current indications of neoadjuvant CRT, and their post-CRT tumor response is assessed by clinical and radiological examinations. However, a model predictive of the CRT response, applied before any treatment commenced, would be valuable to facilitate such a personalized approach. This would increase organ preservation, particularly in patients for whom upfront CRT is not generally prescribed. Molecular biomarkers hold the greatest promise for development of a pretreatment predictive model of CRT response. A combination of clinicopathological, radiological, and molecular markers will be necessary to render the model robust. Molecular research will also contribute to the development of drugs that can overcome the radioresistance of rectal tumors. Current treatments for rectal cancer are based on the expected prognosis given the presenting disease extent. In the future, treatment schemes may be modified by including the predicted CRT response evaluated at presentation.

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Section: No Surgerymentioning

confidence: 99%

Section: No Surgerymentioning

confidence: 99%

Clinical utility of pretreatment prediction of chemoradiotherapy response in rectal cancer: a review

Yoo

Yeo

2017

EPMA Journal

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“…The paradigm of non-operative management of rectal cancer was pioneered in Brazil (91). Cultural differences may trigger and propel surgical development in one part of the world that would probably not have evolved in other places.…”

Section: Study IVmentioning

confidence: 99%

Response to neoadjuvant treatment in rectal cancer surgery

Loftås

2016

Linköping University Medical Dissertations

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Rectal cancer is one of the three most common malignancies in Sweden with an annual incidence of about 2000 cases. Current treatment consists of surgical resection of the rectum including the loco-regional lymph nodes in the mesorectum. In advanced cases, neoadjuvant chemo-radiotherapy (CRT) prior to the operative treatment reduces local recurrences and enables surgery. The neoadjuvant treatment can also eradicate the tumour completely, i.e. complete response. This research project was designed to investigate the effects of preoperative radiotherapy/ CRT and analyze methods to predict response to CRT. Study I investigated the expression of the FXYD-3 protein with immunohistochemistry in rectal cancer, with or without preoperative radiotherapy. The results from the total cohort showed that, strong FXYD-3 expression was correlated to infiltrative tumour growth (p = 0.02). In the radiotherapy group, strong FXYD-3 expression was related to an unfavourable prognosis (p = 0.02). Tumours with strong FXYD-3 expression had less tumour necrosis (p = 0.02) after radiotherapy. FXYD-3 expression in the primary tumour was increased compared to normal mucosa (p=0.008). We concluded that FXYD-3 expression was a prognostic factor in patients receiving preoperative radiotherapy for rectal cancer. Study II investigated FXYD-3 expression in tumours that developed local recurrences following surgery and compared this with expression in tumours that did not develop local recurrences. There was no difference in the expression of FXYD-3 between the group that developed local recurrences and the group that did not develop local recurrences. There was no difference in survival between those with strong or weak FXYD-3 expression. We concluded that this study could not confirm the findings from study 1 i.e. that FXYD-3 expression has prognostic significance in rectal cancer. Study III was a register-based study on the incidence and effects of complete response to neoadjuvant treatment. Eight per cent of the patients with adequate CRT to achieve complete response also had a complete histological response of the luminal tumor in the resected bowel. Sixteen per cent of that group had remaining lymph node metastases in the operative specimen. Chemotherapy together with radiotherapy doubled the chance of complete response in the luminal tumour. Patients with remaining lymph node metastases had a lower survival rate compared to those without. We concluded that residual nodal involvement after neoadjuvant treatment was an important factor for reduced survival after complete response in the luminal tumour. Study IV followed up the results from the previous study by re-evaluating magnetic resonance imaging (MRI)- images in patients with complete tumour response. Two experienced MRI radiologists performed blinded re-staging of post CRT MR- images from patients with complete response in the luminal tumour. One group with lymph node metastases and another one without were studied and the results compared with the pathology reports. The sensitivity, spe...

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“…The described concept has been taken one step further by Habr-Gama (Habr-Gama et al, 2004) who did not find a need for subsequent surgery in patients with clinically complete responses. In her retrospective, long-term, follow-up study which so far has remained unique, she reports a LR rate of only 3% in 100 patients.…”

Section: Tem In Rectal Cancer After Chemoradiationmentioning

confidence: 99%