Avoiding Unnecessary Major Rectal Cancer Surgery by Implementing Structural Restaging and a Watch-and-Wait Strategy After Neoadjuvant Radiochemotherapy
BACKGROUND: Pathologic complete response (pCR) after neoadjuvant chemoradiotherapy (nCRT) is found in 15-20% of patients with locally advanced rectal cancer. A watch-and-wait (W&W) strategy has been introduced as an alternative strategy to avoid surgery for selected patients with a clinical complete response at multidisciplinary response evaluation. The primary aim of this study was to evaluate the efficacy of the multidisciplinary response evaluation by comparing the proportion of patients with pCR since the introduction of the structural response evaluation with the period before response evaluation.
METHODS: This retrospective cohort study enrolled patients with locally advanced rectal cancer who underwent nCRT between January 2009 and May 2018, categorizing them into cohort A (period 2009-2015) and cohort B (period 2015-2018). The patients in cohort B underwent structural multidisciplinary response evaluation with the option of the W&W strategy. Proportion of pCR (ypT0N0), time-to-event (pCR) analysis, and stoma-free survival were evaluated in both cohorts.
RESULTS: Of the 259 patients in the study, 21 (18.4%) in cohort A and in 8 (8.7%) in cohort B had pCR (p = 0.043). Time-to-event analysis demonstrated a significant pCR decline in cohort B (p < 0.001). The stoma-free patient rate was 24% higher in cohort B (p < 0.001).
CONCLUSION: Multidisciplinary clinical response evaluation after nCRT for locally advanced rectal cancer led to a significant decrease in unnecessary surgery for the patients with a complete response.
| Errataetall: |
CommentIn: Ann Surg Oncol. 2021 Dec;28(Suppl 3):862-863. - PMID 33111246 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:28 |
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| Enthalten in: |
Annals of surgical oncology - 28(2021), 5 vom: 10. Mai, Seite 2811-2818 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Huisman, J F [VerfasserIn] |
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Date Completed 14.05.2021 Date Revised 28.01.2022 published: Print-Electronic CommentIn: Ann Surg Oncol. 2021 Dec;28(Suppl 3):862-863. - PMID 33111246 Citation Status MEDLINE |
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| doi: |
10.1245/s10434-020-09192-0 |
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| PPN (Katalog-ID): |
NLM317381407 |
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| 500 | |a CommentIn: Ann Surg Oncol. 2021 Dec;28(Suppl 3):862-863. - PMID 33111246 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: Pathologic complete response (pCR) after neoadjuvant chemoradiotherapy (nCRT) is found in 15-20% of patients with locally advanced rectal cancer. A watch-and-wait (W&W) strategy has been introduced as an alternative strategy to avoid surgery for selected patients with a clinical complete response at multidisciplinary response evaluation. The primary aim of this study was to evaluate the efficacy of the multidisciplinary response evaluation by comparing the proportion of patients with pCR since the introduction of the structural response evaluation with the period before response evaluation | ||
| 520 | |a METHODS: This retrospective cohort study enrolled patients with locally advanced rectal cancer who underwent nCRT between January 2009 and May 2018, categorizing them into cohort A (period 2009-2015) and cohort B (period 2015-2018). The patients in cohort B underwent structural multidisciplinary response evaluation with the option of the W&W strategy. Proportion of pCR (ypT0N0), time-to-event (pCR) analysis, and stoma-free survival were evaluated in both cohorts | ||
| 520 | |a RESULTS: Of the 259 patients in the study, 21 (18.4%) in cohort A and in 8 (8.7%) in cohort B had pCR (p = 0.043). Time-to-event analysis demonstrated a significant pCR decline in cohort B (p < 0.001). The stoma-free patient rate was 24% higher in cohort B (p < 0.001) | ||
| 520 | |a CONCLUSION: Multidisciplinary clinical response evaluation after nCRT for locally advanced rectal cancer led to a significant decrease in unnecessary surgery for the patients with a complete response | ||
| 650 | 4 | |a Journal Article | |
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| 700 | 1 | |a Brohet, R M |e verfasserin |4 aut | |
| 700 | 1 | |a Reerink, O |e verfasserin |4 aut | |
| 700 | 1 | |a van der Sluis, H |e verfasserin |4 aut | |
| 700 | 1 | |a Moll, F C P |e verfasserin |4 aut | |
| 700 | 1 | |a de Boer, E |e verfasserin |4 aut | |
| 700 | 1 | |a de Graaf, J C |e verfasserin |4 aut | |
| 700 | 1 | |a de Vos Tot Nederveen Cappel, W H |e verfasserin |4 aut | |
| 700 | 1 | |a Beets, G L |e verfasserin |4 aut | |
| 700 | 1 | |a van Westreenen, H L |e verfasserin |4 aut | |
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