Organ preservation with chemoradiotherapy plus local excision for rectal cancer: 5-year results of the GRECCAR 2 randomised trial

Rullier, Éric; Vendrely, V.; Asselineau, Julien; Rouanet, Philippe; Tuech, Jean‐Jacques; Valverde, A.; Chaisemartin, Cécile de; Rivoire, Michel; Trilling, Bertrand; Jafari, Mehrdad; Portier, G.; Meunier, Brigitte; Sieleznieff, Igor; Bertrand, Martin; Marchal, Frédéric; Dubois, Anne; Pocard, Marc; Rullier, Anne; Smith, Denis; Frulio, Nora; Frison, Éric; Denost, Quentin

doi:10.1016/s2468-1253(19)30410-8

Cited by 168 publications

(168 citation statements)

References 27 publications

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“…These findings are in line with the recent evidence from the Greccar-2 randomized trial, where in selected patients with a good response after nCRT, no differences were reported between the groups undergoing LE and TME in survival outcomes [35]. In addition, the TREC study demonstrates the feasibility and the organ preservation benefits of a multimodal organ-preservation strategy in early-stage rectal cancer, incorporating SCRT and TEM, compared with radical surgery without radiotherapy [36].…”

Section: Discussionsupporting

confidence: 86%

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Could the conservative approach be considered safe in the treatment of locally advanced rectal cancer in case of a clinical near-complete or complete response? A retrospective analysis

Chiloiro

Meldolesi

Giraffa

et al. 2021

Clinical and Translational Radiation Oncology

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Background: Conservative approach has emerged as an option for the management of rectal cancer (RC) patients with a near or complete clinical response after neoadjuvant chemoradiotherapy (nCRT). The aim of this study is to assess the impact of the conservative approach by comparing patients' survival outcomes and quality of life with those who had surgical resection. Methods: A single-institution and retrospective study including RC patients who reached a near complete or complete clinical response after nCRT from January 2010 to September 2019. Conservative approaches included local excision or watch and wait strategy; surgery approaches included anterior resection or abdominal-perineal resection. Local regrowth (LR), overall survival, disease free survival, metastasis free survival and colostomy free survival were evaluated through Kaplan-Meier curves and compared trough log-rank tests. Quality of life was measured by the following validated questionnaires: EORTC QLC30, EORTC QLQ-CR29 and Fecal Incontinence Quality of Life scale. Results: Overall 157 patients were analyzed: 105 (66,9%) underwent radical surgery and 52 (33,1%) had a conservative approach. With a median follow-up of 51 months, 2 patients in the surgical group had a local recurrence and 8 in the conservative group had a LR, respectively. Distance metastasis occurred in 7 and 1 patients of surgical and conservative group, respectively. No differences were detected in terms of survival outcomes except for colostomy free survival (p: 0,01). The conservative group showed better intestinal (p < 0.01) and sexual (p: 0,04) function and emotional status (p: 0,02). Conclusions: Conservative approach seems to be safe in terms of survival outcomes with a significant advantage on quality of life in RC patients who achieved clinical complete response after nCRT.

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Section: Discussionsupporting

confidence: 86%

“…However, although LR was associated with a higher number of distant metastatic events [23,[34][35][36], in our experience, metastasis seems to be infrequent especially in the conservative approach group (2%), showing no significant differences with surgical patients; only one patient with LR died for several simultaneous distant metastases.…”

Section: Discussioncontrasting

confidence: 55%

Could the conservative approach be considered safe in the treatment of locally advanced rectal cancer in case of a clinical near-complete or complete response? A retrospective analysis

Chiloiro

Meldolesi

Giraffa

et al. 2021

Clinical and Translational Radiation Oncology

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“…30 In the GRECCAR 2 study, tumor regrowth was only 7% after 5 years in the local excision group, albeit those with ≥T2 or R1 disease underwent completion TME. 4 Of the 81 patients treated with local excision in the pre-treatment analysis, 38 (47%) had indications for completion TME with 28 (35%) undergoing TME. The high rate of organ preservation and excellent oncologic results in this study are promising as the GRECCAR 2 cohort included patients with a good response and not just a complete clinical response.…”

Section: Local Excision After Neoadjuvant Chemoradiotherapymentioning

confidence: 98%

Transanal minimally invasive surgery for rectal cancer

Devane

Burke

Kelly

et al. 2020

Annals of Gastroent Surgery

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Due to the increased uptake of rectal cancer screening and the increasing rates of complete clinical response to chemoradiotherapy, more early‐stage and down‐staged rectal cancers are being treated. This has triggered surgeons to question the necessity for proctectomy and its associated morbidity and consider local excision and organ preservation in selected cases. Transanal minimally invasive surgery (TAMIS) has evolved as an oncologically safe yet cost‐effective platform for local excision of rectal tumors using traditional laparoscopic instruments. This review highlights the recent advances and current role of TAMIS in the treatment of rectal cancer.

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“…The French GRECCAR 2 trial was a prospective, multicenter phase 3 trial that randomized patients with cT2/3 N0-1 tumors up to 8 cm from the anal verge and with good response (residual tumor < 2 cm) 6–8 weeks after RCT into an LE versus TME group [ 165 ]. In the LE group, TME completion surgery was performed in case of ypT2-3 or R1.…”

Section: Organ-preserving Surgery and Non-operative Managementmentioning

confidence: 99%

Recent advances in (chemo-)radiation therapy for rectal cancer: a comprehensive review

et al. 2020

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The role of radiation therapy in the treatment of (colo)-rectal cancer has changed dramatically over the past decades. Introduced with the aim of reducing the high rates of local recurrences after conventional surgery, major developments in imaging, surgical technique, systemic therapy and radiation delivery have now created a much more complex environment leading to a more personalized approach. Functional aspects including reduction of acute or late treatment-related side effects, sphincter or even organ-preservation and the unsolved problem of still high distant failure rates have become more important while local recurrence rates can be kept low in the vast majority of patients. This review summarizes the actual role of radiation therapy in different subgroups of patients with rectal cancer, including the current standard approach in different subgroups as well as recent developments focusing on neoadjuvant treatment intensification and/or non-operative treatment approaches aiming at organ-preservation.

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Organ preservation with chemoradiotherapy plus local excision for rectal cancer: 5-year results of the GRECCAR 2 randomised trial

Cited by 168 publications

References 27 publications

Could the conservative approach be considered safe in the treatment of locally advanced rectal cancer in case of a clinical near-complete or complete response? A retrospective analysis

Could the conservative approach be considered safe in the treatment of locally advanced rectal cancer in case of a clinical near-complete or complete response? A retrospective analysis

Transanal minimally invasive surgery for rectal cancer

Recent advances in (chemo-)radiation therapy for rectal cancer: a comprehensive review

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