Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Current Colorectal Cancer Reports
Published in: Current Colorectal Cancer Reports 1/2017

01-02-2017 | Surgery and Surgical Innovations in Colorectal Cancer (S Huerta, Section Editor)

Current Status of the Watch-and-Wait Policy for Patients with Complete Clinical Response Following Neoadjuvant Chemoradiation in Rectal Cancer

Authors: Rob Glynne-Jones, Rob Hughes

Published in: Current Colorectal Cancer Reports | Issue 1/2017

Login to get access

Abstract

Preoperative chemoradiation is the standard of care for patients with locally advanced rectal cancer to reduce the risk of local recurrence. Chemoradiation can achieve a pathological complete response (pCR) in 10–20% of patients when surgery is performed at 4–12 weeks following completion, and a clinical complete response (cCR) in 15–30% if surgery is withheld. The probability of pCR and cCR is partly dependent on initial clinical T- and N-stage. Observational/retrospective studies suggest a selective watch-and-wait policy with rigorous surveillance, avoiding radical surgery, is a safe option to offer patients who achieve a cCR or near cCR. With a watch-and-wait approach, approximately one third will relapse within 12 months, but regrowth is almost invariably endoluminal, and can often be salvaged without compromising overall survival. The aim of this overview is to examine the current status of the watch-and-wait policy for patients with cCR following chemoradiation in rectal cancer.
Literature
1.
Glimelius B, Tiret E, Cervantes A, et al. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24 suppl 6:vi81–8.CrossRefPubMed
2.
National Clinical Practice Guidelines in Oncology (NCCN Guidelines): Rectal Cancer Version 2.2016 www.​ncrn.​org . (last accessed 15/06/2016).
3.
Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351:1731–40.CrossRefPubMed
4.
Gerard JP, Conroy T, Bonnetain F, Bouche O, Chapet O, Closon-Dejardin MT, et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-T4 rectal cancers: results of FFCD 9203. J Clin Oncol. 2006;24:4620–462.CrossRefPubMed
5.
Bosset JF, Collette L, Calais G, Mineur L, Maingon P, Radosevic-Jelic L, et al. Chemoradiotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med. 2006;355:1114–23.CrossRefPubMed
6.
Roh MS, Colangelo LH, O’Connell MJ, et al. Preoperative multimodality therapy improves disease-free survival in patients with carcinoma of the rectum: NSABP R-03. J Clin Oncol. 2009;27:5124–30.CrossRefPubMedPubMedCentral
7.
Dahlberg M, Glimelius B, Bergström R, Påhlman L. Improved survival in patients with rectal cancer: a population based register study. Br J Surg. 1998;85:515–20.CrossRefPubMed
8.
Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001;345:638–46.CrossRefPubMed
9.
Rutten H, den Dulk M, Lemmens V, et al. Survival of elderly rectal cancer patients not improved: analysis of population based data on the impact of TME surgery. Eur J Cancer. 2007;43(15):2295–300.CrossRefPubMed
10.
Guren MG, Kørner H, Pfeffer F, et al. Nationwide improvement of rectal cancer treatment outcomes in Norway, 1993–2010. Acta Oncol. 2015;30:1–9.
11.
Camilleri-Brennan J, Steele RJ. Objective assessment of morbidity and quality of life after surgery for low rectal cancer. Color Dis. 2002;4:61–6.CrossRef
12.
Guren MG, Eriksen MT, Wiig JN, et al. Quality of life and functional outcome following anterior or abdominoperineal resection for rectal cancer. Eur J Surg Oncol. 2005;31(7):735–42.CrossRefPubMed
13.
Den Dulk M, Smit M, Peeters KCMG, et al. A multivariate analysis of limiting factors for stoma reversal in patients with rectal cancer entered into the total mesorectal excision (TME) trial: a retrospective study. Lancet Oncol. 2007;8:297–303.CrossRef
14.
Harrison JD, Solomon MJ, Young JM, et al. Patient and physician preferences for surgical and adjuvant treatment options for rectal cancer. Arch Surg. 2008;143:389–94.CrossRefPubMed
15.
Kim YA, Lee GJ, Park SW, Lee WS, Baek JH. Multivariate analysis of risk factors associated with the nonreversal ileostomy following sphincter-preserving surgery for rectal cancer. Ann Coloproctol. 2015;31(3):98–102.CrossRefPubMedPubMedCentral
16.
Celerier B, Denost Q, Van Geluwe B, Pontallier A, Rullier E. The risk of definitive stoma formation at 10 years after low and ultralow anterior resection for rectal cancer. Color Dis. 2016;18(1):59–66.CrossRef
17.
Emmertsen KJ, Laurberg S. Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg. 2012;255(5):922–8.CrossRefPubMed
18.
• Bregendahl S, Emmertsen KJ, Lous J, Laurberg S. Bowel dysfunction after low anterior resection with and without neoadjuvant therapy for rectal cancer: a population-based cross-sectional study. Color Dis. 2013;15(9):1130–9. Important study shows how common LARS syndrome is and how badly affected by radiotherapy.
19.
Pietrzak L, Bujko K, Nowacki MP, Polish Colorectal Study Group, et al. Quality of life, anorectal and sexual functions after preoperative radiotherapy for rectal cancer: report of a randomised trial. Radiother Oncol. 2007;84(3):217–25.CrossRefPubMed
20.
Smith FM, Rao C, Oliva Perez R, Bujko K, Athanasiou T, Habr-Gama A, et al. Avoiding radical surgery improves early survival in elderly patients with rectal cancer, demonstrating complete clinical response after neoadjuvant therapy: results of a decision-analytic model. Dis Colon Rectum. 2015;58(2):159–71.CrossRefPubMed
21.
Heald RJ, Beets G, Carvalho C. Report from a consensus meeting: response to chemoradiotherapy in rectal cancer—predictor of cure and a crucial new choice for the patient: on behalf of the Champalimaud 2014 Faculty for ‘Rectal cancer: when NOT to operate. Color Dis. 2014;16(5):334–7.CrossRef
22.
Ellis CT, Samuel CA, Stitzenberg KB. National trends in nonoperative management of rectal adenocarcinoma. J Clin Oncol. 2016;34(14):1644–51.CrossRefPubMed
23.
Abrams MJ, Koffer PP, Leonard KL. The emerging non-operative management of non-metastatic rectal cancer: a population analysis. Anticancer Res. 2016;36(4):1699–702.PubMed
24.
Ellis CT, Dusetzina SB, Sanoff H, Stitzenberg KB. Long-term survival after chemoradiotherapy without surgery for rectal adenocarcinoma: a word of caution. JAMA Oncol. 2016.
25.
Habr-Gama A, Perez RO. No surgery after chemoradiation is not equal to nonoperative management after complete clinical response and chemoradiation. J Clin Oncol. 2016 Aug 15.
26.
Bujko K, Michalski W, Kepka L, et al. Polish Colorectal Study Group. Association between pathologic response in metastatic lymph nodes after preoperative chemoradiotherapy and risk of distant metastases in rectal cancer: an analysis of outcomes in a randomized trial. Int J Radiat Oncol Biol Phys. 2007;67(2):369–77.CrossRefPubMed
27.
Rödel C, Martus P, Papadoupolos T, Füzesi L, Klimpfinger M, Fietkau R, et al. Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol. 2005;23(34):8688–96.CrossRefPubMed
28.
Habr-Gama A, Lynn PB, Jorge JM, São Julião GP, Proscurshim I, Gama-Rodrigues J, et al. Impact of organ-preserving strategies on anorectal function in patients with distal rectal cancer following neoadjuvant chemoradiation. Dis Colon Rectum. 2016;59(4):264–9.CrossRefPubMed
29.
•• Martens MH, Maas M, Heijnen LA, Lambregts DM, Leijtens JW, Stassen LP, Breukink SO, Hoff C, Belgers EJ, Melenhorst J, Jansen R, Buijsen J, Hoofwijk TG, Beets-Tan RG, Beets GL. Long-term outcome of an organ preservation program after neoadjuvant treatment for rectal cancer. J Natl Cancer Inst. 2016 Aug 10;108(12). Very important study confirming feasibility and safety of watch –and wait using very meticulous imaging/follow-up.
30.
Habr-Gama A, Sabbaga J, Gama-Rodrigues J, et al. Watch and wait approach following extended neoadjuvant chemoradiation for distal rectal cancer: are we getting closer to anal cancer management? Dis Colon Rectum. 2013;56(10):1109–17.CrossRefPubMed
31.
Habr-Gama A, Gama-Rodrigues J, São Julião GP, et al. Local recurrence after complete clinical response and watch and wait in rectal cancer after neoadjuvant chemoradiation: impact of salvage therapy on local disease control. Int J Radiation Oncol Biol Phys. 2014;88(4):822–8.CrossRef
32.
Maas M, Nelemans PJ, Valentini V, et al. Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patients. Lancet Oncol. 2010;11(9):835–44.CrossRefPubMed
33.
Martin ST, Heneghan HM, Winter DC. Systematic review and meta-analysis of outcomes following pathological complete response to neoadjuvant chemoradiotherapy for rectal cancer. Br J Surg. 2012;99(7):918–28.CrossRefPubMed
34.
Hughes R, Glynne-Jones R, Grainger J, et al. Can pathological complete response in the primary tumour following pre-operative pelvic chemoradiotherapy for T3-T4 rectal cancer predict for sterilisation of pelvic lymph nodes, a low risk of local recurrence and the appropriateness of local excision? Int J Color Dis. 2006;21:11–7.CrossRef
35.
• Loftås P, Arbman G, Fomichov V, Hallböök O. Nodal involvement in luminal complete response after neoadjuvant treatment for rectal cancer. EJSO. 2016;42(6):801–7. Important study suggests patients with clinically positive nodes less likely to achieve pCR.CrossRefPubMed
36.
Sprenger T, Rothe H, Becker H, Beissbarth T, Homayounfar K, Gauss K, et al. Lymph node metastases in rectal cancer after preoperative radiochemotherapy: impact of intramesorectal distribution and residual micrometastatic involvement. Am J Surg Pathol. 2013;37(8):1283–9.CrossRefPubMed
37.
Glynne-Jones R, Hughes R. Critical appraisal of the ‘wait and see’ approach in rectal cancer for clinical complete responders after chemoradiation. Clin Onc (R Coll Radiol). 2015.
38.
Habr-Gama A, de Souza PM, Ribeiro U, Nadalin W, Sousa GR, Jr AH, et al. Low rectal cancer: impact of radiation and chemotherapy on surgical treatment. Dis Colon Rectum. 1998;41:1087–96.CrossRefPubMed
39.
Habr-Gama A, Perez RO, Nadalin W, et al. Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results. Ann Surg. 2004;240(4):711–7.PubMedPubMedCentral
40.
Habr-Gama A, Perez RO, Nadalin W, Nahas SC, Ribeiro Jr U, Silva E Sousa Jr AH, et al. Long term results of preoperative chemoradiation for distal rectal cancer: correlation between final stage and survival. J Gastrointest Surg. 2005;9:90–101.CrossRefPubMed
41.
Habr-Gama A, Perez RO, Proscurshim I, et al. Patterns of failure and survival for nonoperative treatment of stage c0 distal rectal cancer following neoadjuvant chemoradiation therapy. J Gastrointest Surg. 2006;10(10):1319–28.CrossRefPubMed
42.
Habr-Gama A, Perez RO, Proscurshim I, et al. Interval between surgery and neoadjuvant chemoradiation therapy for distal rectal cancer: does delayed surgery have an impact on outcome? Int J Radiat Oncol Biol Phys. 2008;71(4):1181–8.CrossRefPubMed
43.
Habr-Gama A, Gama-Rodrigues J, Perez RO, Proscurshim I, São Julião GP, Kruglensky D, et al. Late assessment of local control by PET in patients with distal rectal cancer managed non-operatively after complete tumor regression following neoadjuvant chemoradiation. Technol Coloproctol. 2008;12(1):74–6.
44.
Habr-Gama A, Perez RO, Sabbaga J, Nadalin W, São Julião GP, Gama-Rodrigues J. Increasing the rates of complete response to neoadjuvant chemoradiotherapy for distal rectal cancer: results of a prospective study using additional chemotherapy during the resting period. Dis Colon Rectum. 2009;52(12):1927–34.CrossRefPubMed
45.
Habr-Gama A, Perez RO, Wynn G, Marks J, Kessler H, Gama-Rodrigues J. Complete clinical response after neoadjuvant chemoradiation therapy for distal rectal cancer: characterization of clinical and endoscopic findings for standardization. Dis Colon Rectum. 2010;53(12):1692–8.CrossRefPubMed
46.
Habr-Gama A, Perez RO, São Julião GP, Proscurshim I, Gama-Rodrigues J. Nonoperative approaches to rectal cancer: a critical evaluation. Semin Radiat Oncol. 2011;21(3):234–9.CrossRefPubMed
47.
Habr-Gama A, Perez RO, Lynn PB, Sao Juliao GP, Gama-Rodrigues J. Selective non-operative management of distal rectal cancer: the Watch and Wait Protocol. In: Schiessel RMP, editor. Intersphincteric resection for low tumors of the rectum. New York: Springer-Verlag/Wien; 2012. p. 43–53.CrossRef
48.
Perez RO, Habr-Gama A, São Julião GP, Gama-Rodrigues J, Sousa Jr AH, Campos FG, et al. Optimal timing for assessment of tumor response to neoadjuvant chemoradiation in patients with rectal cancer: do all patients benefit from waiting longer than 6 weeks? Int J Radiat Oncol Biol Phys. 2012;84(5):1159–65.CrossRefPubMed
49.
Habr-Gama A, Sabbaga J, Gama-Rodrigues J, São Julião GP, Proscurshim I, Bailão Aguilar P, et al. Watch and wait approach following extended neoadjuvant chemoradiation for distal rectal cancer: are we getting closer to anal cancer management? Dis Colon Rectum. 2013;56(10):1109–17.CrossRefPubMed
50.
Perez RO, Habr-Gama A, São Julião GP, Lynn PB, Sabbagh C, Proscurshim I, et al. Predicting complete response to neoadjuvant CRT for distal rectal cancer using sequential PET/CT imaging. Technol Coloproctol. 2014;18(8):699–708.CrossRef
51.
Habr-Gama A, São Julião GP, Perez RO. Nonoperative management of rectal cancer: identifying the ideal patients. Hematol Oncol Clin North Am. 2015;29(1):135–51.CrossRefPubMed
52.
• Habr-Gama A, Perez RO, São Julião GP, Proscurshim I, Fernandez LM, Figueiredo MN, et al. Consolidation chemotherapy during neoadjuvant chemoradiation (CRT) for distal rectal cancer leads to sustained decrease in tumor metabolism when compared to standard CRT regimen. Radiat Oncol. 2016;11:24. Important study showing the potential value of PET/CT in determining intensification of treatment to achieve complete response.CrossRefPubMedPubMedCentral
53.
Maas M, Beets-Tan RG, Lambregts DM, et al. Wait-and-see policy for clinical complete responders after chemoradiation for rectal cancer. J Clin Oncol. 2011;29(35):4633–40.CrossRefPubMed
54.
Rossi B, Nakagawa W, Novaes P, Filho WD, Lopes A. Radiation and chemotherapy instead of surgery for low infiltrative rectal adenocarcinoma: a prospective trial. Ann Surg Oncol. 1998;5(2):113–8.CrossRefPubMed
55.
Lim L, Chao M, Shapiro J, Millar JL, Kipp D, Rezo A, et al. Long term outcomes of patients with localized rectal cancer treated with chemoradiation or radiotherapy alone because of medical inoperability or patient refusal. Dis Colon Rectum. 2007;50(12):2032–9.CrossRefPubMed
56.
Hughes R, Harrison M, Glynne-Jones R. Could a wait and see policy be justified in T3/4 rectal cancers after chemo-radiotherapy? Acta Oncol. 2010;49(3):378–81.CrossRefPubMed
57.
Aylour SR, Kondaveeti SS, Jayanand SB, et al. Complete clinical response to neoadjuvant chemoradiation in rectal cancers: can surgery be avoided? Hepatogastroenterol. 2013;60(123):410–4.
58.
Yu SK, Brown G, Heald RJ. Deferral of rectal surgery following a continued response to preoperative chemoradiotherapy (Watch and Wait) study: a phase II multicenter study in the United Kingdom. J Clin Oncol 29: 2011 (suppl 4; abstr 489).
59.
Dalton RS, Velineni R, Osborne ME, et al. A single-centre experience of chemoradiotherapy for rectal cancer: is there potential for nonoperative management? Color Dis. 2012;14(5):567–71.CrossRef
60.
Smith JD, Ruby JA, Goodman KA, et al. Nonoperative management of rectal cancer with complete clinical response after neoadjuvant therapy. Ann Surg. 2012;256(6):965–72.CrossRefPubMed
61.
Yeo SG, Kim DY, Oh JH. Long-term survival without surgery following a complete response to pre-operative chemoradiotherapy for rectal cancer: a case series. Oncol Lett. 2013;6(6):1573–6.PubMedPubMedCentral
62.
Smith JJ, Chow OS, Eaton A, et al.: Organ preservation in patients with rectal cancer with clinical complete response after neoadjuvant therapy. 2015 Gastrointestinal Cancers Symposium. Abstract 509. Presented January 17, 2015.
63.
Smith RK, Fry RD, Mahmoud NN, Paulson EC. Surveillance after neoadjuvant therapy in advanced rectal cancer with complete clinical response can have comparable outcomes to total mesorectal excision. Int J Color Dis. 2015;30(6):769–74.CrossRef
64.
Marincaş AM, Prunoiu VM, Brătucu E, Cirimbei C, Ionescu S, Buzatu R, et al. Clinical and paraclinical criteria of patient selection for the non-operative treatment in completely responsive rectal cancer (after neoadjuvant radiochemotherapy). Chirurgia (Bucur). 2015;110(4):351–5.
65.
Araujo RO, Valadao M, Borges D, et al. Nonoperative management of rectal cancer after chemoradiation opposed to resection after complete clinical response. A comparative study. Eur J Surg Oncol. 2015;41(11):1456–63.CrossRefPubMed
66.
Appelt AL, Pløen J, Harling H, Jensen FS, Jensen LH, Jørgensen JC, et al. High-dose chemoradiotherapy and watchful waiting for distal rectal cancer: a prospective observational study. Lancet Oncol. 2015;16(8):919–27.CrossRefPubMed
67.
Vaccaro CA, Yazyi FJ, Ojra Quintana G, Santino JP, Sardi ME, Beder D, et al. Locally advanced rectal cancer: preliminary results of rectal preservation after neoadjuvant chemoradiotherapy. Cir Esp. 2016;94(5):274–9.CrossRefPubMed
68.
Sanchez Loria F, Iseas S, O’Connor JM, Pairola A, Chacon M, Mendez G, Coraglio M, Mariani J, Dieguez A, Roca E, Huertas E. Non-surgical management (NSM) of rectal cancer. Series of 68 cases, long follow up in two leading centres in Argentina. Dig Liver Dis. 2016.
69.
Renehan AG, Malcomson L, Emsley R, Gollins S, Maw A, Myint AS, et al. Watch-and-wait approach versus surgical resection after chemoradiotherapy for patients with rectal cancer (the OnCoRe project): a propensity-score matched cohort analysis. Lancet Oncol. 2016;17(2):174–83.CrossRefPubMed
70.
MERCURY Study Group. Extramural depth of tumor invasion at thin-section MR in patients with rectal cancer: results of the MERCURY study. Radiology. 2007;243(1):132–9.CrossRef
71.
Rullier E, Rouanet P, Michot F, et al. Local versus rectal excision in downstaged low rectal cancer after radiochemotherapy: preliminary results of the randomized GRECCAR 2 trial. Color Dis. 2013;15(suppl3):7.
72.
Garcia-Aguilar J, Renfro LA, Chow OS, Shi Q, Carrero XW, Lynn PB, et al. Organ preservation for clinical T2N0 distal rectal cancer using neoadjuvant chemoradiotherapy and local excision (ACOSOG Z6041): results of an open-label, single-arm, multi-institutional, phase 2 trial. Lancet Oncol. 2015;16(15):1537–46.CrossRefPubMedPubMedCentral
73.
Rasanen M, Ristimäki A, Savolainen R, Renkonen-Sinisalo L, Lepistö A. Oncological results of extended resection for locally advanced rectal cancer: the value of the post-irradiation MRI in predicting local recurrence. Color Dis. 2016. doi:10.​1111/​codi.​13513.
74.
Moureau-Zabotto L, Farnault B, de Chaisemartin C, Esterni B, Lelong B, Viret F, et al. Predictive factors of tumor response after neoadjuvant chemoradiation for locally advanced rectal cancer. Int J Radiat Oncol Biol Phys. 2011;80(2):483–91.CrossRefPubMed
75.
Russo AL, Ryan DP, Borger DR, Wo JY, Szymonifka J, Liang WY, et al. Mutational and clinical predictors of pathologic complete response in the treatment of locally advanced rectal cancer. J Gastrointest Cancer. 2014;45(1):34–9.CrossRefPubMedPubMedCentral
76.
Oberholzer K, Menig M, Kreft A, Schneider A, Junginger T, Heintz A, et al. Rectal cancer: mucinous carcinoma on magnetic resonance imaging indicates poor response to neoadjuvant chemoradiation. Int J Radiat Oncol Biol Phys. 2012;82(2):842–8.CrossRefPubMed
77.
Peng JY, Li ZN, Wang Y. Clinical factors of post-chemoradiotherapy as valuable indicators for pathological complete response in locally advanced rectal cancer. World J Gastroenterol. 2013;19(32):5227–37.CrossRefPubMedPubMedCentral
78.
Bhoday J, Smith F, Siddiqui MR, et al. Magnetic resonance tumor regression grade and residual mucosal abnormality as predictors for pathological complete response in rectal cancer postneoadjuvant chemoradiotherapy. Dis Colon Rectum. 2016;59(10):925–33.CrossRefPubMed
79.
Kleiman A, Al-Khamis A, Farsi A, et al. Normalization of CEA levels post-neoadjuvant therapy is a strong predictor of pathologic complete response in rectal cancer. J Gastrointest Surg. 2015;19:1106–12.CrossRefPubMed
80.
Engels B, Tournel K, Everaert H, et al. Phase II study of preoperative helical tomotherapy with a simultaneous integrated boost for rectal cancer. Int J Radiat Oncol Biol Phys. 2012;83(1):142–8.CrossRefPubMed
81.
Samuelian JM, Callister MD, Ashman JB, et al. Reduced acute bowel toxicity in patients treated with intensity-modulated radiotherapy for rectal cancer. Int J Radiat Oncol Biol Phys. 2012;82:1981–7.CrossRefPubMed
82.
Hernando-Requejo O, López M, Cubillo A, et al. Complete pathological responses in locally advanced rectal cancer after preoperative IMRT and integrated-boost chemoradiation. Strahlenther Onkol. 2014;190(6):515–20
83.
Burbach JP, den Harder AM, Intven M, van Vulpen M, Verkooijen HM, Reerink O. Impact of radiotherapy boost on pathological complete response in patients with locally advanced rectal cancer: a systematic review and meta-analysis. Radiother Oncol. 2014;113(1):1–9.CrossRefPubMed
84.
Gerard JP, Benezery K, Doyen J, Francois E. Aims of combined modality therapy in rectal cancer (M0). Recent Results Cancer Res. 2014;203:153–69.CrossRefPubMed
85.
Jakobsen A, Ploen J, Vuong T, Appelt A, Lindebjerg J, Rafaelsen SR. Dose-effect relationship in chemoradiotherapy for locally advanced rectal cancer: a randomized trial comparing two radiation doses. Int J Radiat Oncol Biol Phys. 2012;84(4):949–5.CrossRefPubMed
86.
Appelt AL, Pløen J, Vogelius IR, Bentzen SM, Jakobsen A. Radiation dose-response model for locally advanced rectal cancer after preoperative chemoradiation therapy. Int J Radiat Oncol Biol Phys. 2013;85(1):74–80.CrossRefPubMed
87.
Gérard JP, Azria D, Gourgou-Bourgade S, et al. Comparison of two neoadjuvant chemoradiotherapy regimens for locally advanced rectal cancer: results of the phase III trial ACCORD 12/0405-Prodige 2. J Clin Oncol. 2010;28(10):1638–44.CrossRefPubMed
88.
Rödel C, Liersch T, Becker H, Fietkau R, German Rectal Cancer Study Group, et al. Preoperative chemoradiotherapy and postoperative chemotherapy with fluorouracil and oxaliplatin versus fluorouracil alone in locally advanced rectal cancer: initial results of the German CAO/ARO/AIO-04 randomised phase 3 trial. Lancet Oncol. 2012;13(7):679–87.CrossRefPubMed
89.
Bujko K, Wyrwicz L, Rutkowski A, et al. Long-course oxaliplatin-based preoperative chemoradiation versus 5 × 5 Gy and consolidation chemotherapy for cT4 or fixed cT3 rectal cancer: results of a randomized phase III study. Ann Oncol. 2016;27(5):834–42.CrossRefPubMed
90.
Maas M, Lambregts DM, Nelemans PJ, et al. Assessment of clinical complete response after chemoradiation for rectal cancer with digital rectal examination, endoscopy, and MRI: selection for organ-saving treatment. Ann Surg Oncol. 2015.
91.
Lim SG, Kim YB, Oh SY. Clinical significance of the endoscopic finding in predicting complete tumor response to preoperative chemoradiation therapy in rectal cancer. World J Surg. 2016.
92.
Perez RO, Habr-Gama A, Pereira GV, Lynn PB, Alves PA, Proscurshim I, et al. Role of biopsies in patients with residual rectal cancer following neoadjuvant chemoradiation after downsizing: can they rule out persisting cancer? Color Dis. 2012;14(6):714–20.CrossRef
93.
Smith FM, Wiland H, Mace A, Pai RK, Kalady MF. Assessment of a novel, full-thickness incisional biopsy model to restage rectal tumours after neoadjuvant chemoradiotherapy: results of an ex vivo pilot study. Technol Coloproctol. 2015;19(3):159–64.CrossRef
94.
Smith FM, Wiland H, Mace A, Pai RK, Kalady MF. Depth and lateral spread of microscopic residual rectal cancer after neoadjuvant chemoradiation: implications for treatment decisions. Color Dis. 2014;16(8):610–5.CrossRef
95.
Zhao R-S, Wang H, Zhou Z-Y, Zhou Q, Mulholland MW. Restaging of locally advanced rectal cancer with magnetic resonance imaging and endoluminal ultrasound after preoperative chemoradiotherapy. Dis Colon Rectum. 2014;57(3):388–95.CrossRefPubMed
96.
Perez RO, Habr-Gama A, Smith FM, et al. Fragmented pattern of tumor regression and lateral intramural spread may influence margin appropriateness after TEM for rectal cancer following neoadjuvant CRT. J Surg Oncol. 2014;109(8):853–8.CrossRefPubMed
97.
van der Paardt MP, Zagers MB, Beets-Tan RG, et al. Patients who undergo preoperative chemoradiotherapy for locally advanced rectal cancer restaged by using diagnostic MR imaging: a systematic review and meta-analysis. Radiology. 2013;269:101–22.CrossRefPubMed
98.
Heijnen LA, Maas M, Beets-Tan RG, Berkhof M, Lambregts DM, Nelemans PJ, et al. Nodal staging in rectal cancer: why is restaging after chemoradiation more accurate than primary nodal staging? Int J Color Dis. 2016;31(6):1157–62.CrossRef
99.
Lambregts DM, Vandecaveye V, Barbaro B, Bakers FC, Lambrecht M, Maas M, et al. Diffusion-weighted MRI for selection of complete responders after chemoradiation for locally advanced rectal cancer: a multicenter study. Ann Surg Oncol. 2011;18(8):2224–31.CrossRefPubMedPubMedCentral
100.
Siddiqui MR, Gormly KL, Bhoday J, Balyansikova S, Battersby NJ, Chand M, et al. Interobserver agreement of radiologists assessing the response of rectal cancers to preoperative chemoradiation using the MRI tumour regression grading (mrTRG). Clin Radiol. 2016;71(9):854–62.CrossRefPubMed
101.
van Stiphout RG, Valentini V, Buijsen J, Lammering G, Meldolesi E, van Soest J, et al. Nomogram predicting response after chemoradiotherapy in rectal cancer using sequential PETCT imaging: a multicentric prospective study with external validation. Radiother Oncol. 2014;113(2):215–22.CrossRefPubMed
102.
Li QW, Zheng RL, Ling YH, Wang QX, Xiao WW, Zeng ZF, et al. Prediction of tumor response after neoadjuvant chemoradiotherapy in rectal cancer using (18)fluorine-2-deoxy-D-glucose positron emission tomography-computed tomography and serum carcinoembryonic antigen: a prospective study. Abdom Radiol (NY). 2016;41(8):1448–55.CrossRef
103.
De Cecco CN, Ciolina M, Caruso D, Rengo M, Ganeshan B, Meinel FG, et al. Performance of diffusion-weighted imaging, perfusion imaging, and texture analysis in predicting tumoral response to neoadjuvant chemoradiotherapy in rectal cancer patients studied with 3T MR: initial experience. Abdom Radiol (NY). 2016;41(9):1728–35.CrossRefPubMed
104.
• Evans J, Bhoday J, Sizer B et al., Results of a prospective randomised control 6 vs 12 trial: is greater tumour downstaging observed on post treatment MRI if surgery is delayed to 12-weeks versus 6-weeks after completion of neoadjuvant chemoradiotherapy? Ann Oncol 2016;27(suppl 6):vi149 (abstract 4520). Randomised, multicentre trial was undertaken to determine whether greater rectal cancer downstaging and regression occurs when surgery is delayed to 12 compared to 6-weeks. Of 237 patients randomised: more downstaged in the 12-week (58%) compared with 43% in the 6-week arm (p = 0.019). The pCR rate was 9% in the 6-week versus 20% for the 12-week arm (p < 0.05).
105.
• Lefevre JH, Mineur L, Kotti S, Rullier E, Rouanet P, de Chaisemartin C, et al. Effect of interval (7 or 11 weeks) between neoadjuvant radiochemotherapy and surgery on complete pathologic response in rectal cancer: a multicenter, randomized, controlled trial (GRECCAR-6). J Clin Oncol. 2016. 265 patients randomised between surgery at 7-week point or the 11-week point. The majority of the tumors were cT3 (82%). The primary end point (ypT0N0) was not different ie 7 weeks arm: 20/133 (15%) versus 11 week arm: 23/132, (17.4%); P = .5983). Morbidity was significantly increased in the 11 week group (44.5% v 32%; P = .0404).
106.
Garcia-Aguilar J, Chow OS, Smith DD, Marcet JE, Cataldo PA, Varma MG, et al. Timing of rectal cancer response to chemoradiation consortium. Effect of adding mFOLFOX6 after neoadjuvant chemoradiation in locally advanced rectal cancer: a multicentre, phase 2 trial. Lancet Oncol. 2015;16(8):957–66.CrossRefPubMedPubMedCentral
107.
Habr-Gama A, Lynn PB, Jorge JM, São Julião GP, Proscurshim I, Gama-Rodrigues J, et al. Impact of organ-preserving strategies on anorectal function in patients with distal rectal cancer following neoadjuvant chemoradiation. Dis Colon Rectum. 2016;59(4):264–9.CrossRefPubMed
Metadata
Title
Current Status of the Watch-and-Wait Policy for Patients with Complete Clinical Response Following Neoadjuvant Chemoradiation in Rectal Cancer
Authors
Rob Glynne-Jones
Rob Hughes
Publication date
01-02-2017
Publisher
Springer US
Published in
Current Colorectal Cancer Reports / Issue 1/2017
Print ISSN: 1556-3790
Electronic ISSN: 1556-3804
DOI
https://doi.org/10.1007/s11888-017-0344-y

Other articles of this Issue 1/2017

Current Colorectal Cancer Reports 1/2017 Go to the issue

Surgery and Surgical Innovations in Colorectal Cancer (S Huerta, Section Editor)

Robotic Surgery for Colon and Rectal Cancer: Current Status, Recent Advances, and Future Directions

Personalized Medicine in Colorectal Cancer (D Cunningham and EC Smyth, Section Editors)

Molecular Stratification of Colorectal Cancer: Moving from the Laboratory to Clinical Practice

Hot Topic

Multidisciplinary Management of Rectal Cancer with Synchronous Resectable Liver Metastases

Radiation Therapy and Radiation Therapy Innovations in Colorectal Cancer (JY Wo, Section Editor)

The Impact of Novel Radiation Treatment Techniques on Toxicity and Clinical Outcomes in Rectal Cancer

Surgery and Surgical Innovations in Colorectal Cancer (S Huerta, Section Editor)

Current Concepts on the Distal Margin of Resection of Rectal Cancer Tumors after Neoadjuvant Chemoradiation

Surgery and Surgical Innovations in Colorectal Cancer (S Huerta, Section Editor)

Current Status of Laparoscopic Surgery in Colorectal Cancer
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits