Watch-and-wait approach versus surgical resection after chemoradiotherapy for patients with rectal cancer (the OnCoRe project): a propensity-score matched cohort analysis

Renehan, Andrew G; Malcomson, Lee; Emsley, Richard; Gollins, Simon; Maw, Andrew; Myint, Arthur Sun; Rooney, Paul; Susnerwala, Shabbir; Blower, Anthony; Saunders, Mark; Wilson, Malcolm S; Scott, Nigel; O’Dwyer, Sarah T

doi:10.1016/s1470-2045(15)00467-2

Cited by 614 publications

(450 citation statements)

References 33 publications

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“…This non-operative approach is under investigation at multiple sites worldwide [35][36][37]. In the UK, 129 patients with cCR were thus managed [37].…”

Section: No Surgerymentioning

confidence: 99%

“…In the UK, 129 patients with cCR were thus managed [37]. At a median follow-up of 33 months, 44 (34%) exhibited local regrowth (3-year actuarial rate, 38%).…”

Section: No Surgerymentioning

confidence: 99%

“…The current indication for nCRT is LARC, although the argument has been made that patients with relatively low-risk LARCs, such as cT3N0 cancers or upper rectal cancers, do not need to undergo nCRT [4,40,41]. Clinical examinations, including endoscopic findings and digital rectal evaluations, and radiological studies, play major roles in such evaluation [35][36][37]42].…”

Section: Prediction Of Crt Responsementioning

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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“…This non-operative approach is under investigation at multiple sites worldwide [35][36][37]. In the UK, 129 patients with cCR were thus managed [37].…”

Section: No Surgerymentioning

confidence: 99%

“…In the UK, 129 patients with cCR were thus managed [37]. At a median follow-up of 33 months, 44 (34%) exhibited local regrowth (3-year actuarial rate, 38%).…”

Section: No Surgerymentioning

confidence: 99%

Section: Prediction Of Crt Responsementioning

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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“…Consequently, standard clinical practice in many parts of the world is to treat locally advanced disease with long-course CRT, with delayed surgery after 6-12 weeks. The typical long-course CRT regimen consists of [45][46][47][48][49][50] Gy to the primary tumour and the regional lymph node stations, delivered over 5-6 weeks in daily 1.8-2.0 Gy fractions, with concomitant fluorouracilbased chemotherapy. However, neoadjuvant treatment strategies are increasingly individualised; in terms of treatment modality, radiotherapy dose and schedule, details of treatment technique, and choice of chemotherapy regimens (4).…”

Section: Introductionmentioning

confidence: 99%

Technological advances in radiotherapy of rectal cancer: opportunities and challenges

Appelt

Sebag‐Montefiore

2016

Current Opinion in Oncology

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Purpose of review:This review summarizes the available evidence for the use of modern radiotherapy techniques for chemoradiotherapy (CRT) for rectal cancer, with specific focus on intensity-modulated radiotherapy (IMRT) and volumetric arc therapy (VMAT) techniques. Recent findings:The dosimetric benefits of IMRT and VMAT are well-established, but prospective clinical studies are limited, with phase I-II studies only. Recent years have seen the publication of a few larger prospective patient series as well as some retrospective cohorts, several of which include much needed late toxicity data. Overall results are encouraging, as toxicity levels although varying across reports appear lower than for 3D conformal radiotherapy. Innovative treatment techniques and strategies which may be facilitated by the use of IMRT/VMAT include simultaneously integrated tumour boost, adaptive treatment, selective sparing of specific organs to enable chemotherapy escalation, and non-surgical management. Summary:Few prospective studies of IMRT and VMAT exist, which causes uncertainty not just in regards to the clinical benefit of these technologies but also in the optimal use. The priority for future research should be subgroups of patients who might receive relatively greater benefit from innovative treatment techniques, such as patients receiving CRT with definitive intent and patients treated with dose escalation.

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“…У пациентов с радиочув-ствительными опухолями регрессия может достичь полного клинического и патоморфологического отве-та, что сопровождается тотальным замещением опухо-ли фиброзными тканями. Выполнение хирургического вмешательства в таком случае, по мнению некоторых авторов, является излишним, подвергающим пациен-та рискам, связанным с осложнениями, послеопера-ционной летальностью, нарушениями мочеполовой функции и формированием постоянной колостомы [5,6].…”

unclassified

Organ Saving Treatment of Rectal Cancer

Расулов¹,

Мамедли²,

Кузьмичев³

et al. 2016

Onkol. koloproktol.

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Watch-and-wait approach versus surgical resection after chemoradiotherapy for patients with rectal cancer (the OnCoRe project): a propensity-score matched cohort analysis

Cited by 614 publications

References 33 publications

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

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

Technological advances in radiotherapy of rectal cancer: opportunities and challenges

Organ Saving Treatment of Rectal Cancer

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