Complete Clinical Response in Rectal Cancer After Neoadjuvant Therapy: Organ Preservation Strategies and the Role of Surgery

2019 ◽  
pp. 31-41
Author(s):  
Laura Melina Fernandez ◽  
Guilherme Pagin São Julião ◽  
Bruna Borba Vailati ◽  
Angelita Habr-Gama ◽  
Rodrigo O. Perez
Keyword(s):  
Rectal Cancer ◽  
Clinical Response ◽  
Neoadjuvant Therapy ◽  
Organ Preservation ◽  
Complete Clinical Response

The feasibility and efficiency of wait and see policy for patients with complete clinical response following neoadjuvant therapy in rectal cancer: A prospective cohort study from China.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 3610-3610 ◽  
Author(s):  
Jin Gu ◽  
Changzheng Du ◽  
Ming Li ◽  
Yifan Peng ◽  
Yunfeng Yao ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Cohort Study ◽  
Clinical Response ◽  
Neoadjuvant Therapy ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Locally Advanced ◽  
Complete Clinical Response ◽  
Surgery Group ◽  
Wait And See

3610 Background: It has been reported that non-operative treatment (wait and see) is feasible for the selected rectal cancer cases with a complete clinical response (cCR) following neoadjuvant therapy (NT). The aim of this study is to determine whether "wait and see" policy is efficient for the cCR patients in China. Methods: We designed a prospective cohort study in China (ChiCTR-TRC-12002488). From Jul 2012 to August 2016, totally 45 patients with locally advanced rectal cancer who were cCR following NT were enrolled in the study; within whom, 32 patients were assigned to wait and see group, and the remaining 13 patients were assigned to surgery group (intent-to-treat grouping). Results: The median follow-up time was 24 months (range: 3-51). Of the patients who were followed up more than 12 months (n=37), 8 patients developed tumor progression (7 in wait and see group and 1 in surgery group, respectively). In the wait and see group, the local regrowth took an account of 23.1% (6/26), while the distant metastasis rate was 3.8% (1/26). In the surgery group, there were 23.1% (3/13) of patients who has residual cancer confirmed by postoperative pathological assessment. All the patients with tumor regrowth underwent radical surgery and no body died of cancer. Conclusions: Wait and see policy has an acceptable safety and efficiency, it may become an alternative treatment for the patients who were cCR following NT. Clinical trial information: ChiCTR-TRC-12002488. [Table: see text]

Avoiding Radical Surgery Improves Early Survival in Elderly Patients With Rectal Cancer, Demonstrating Complete Clinical Response After Neoadjuvant Therapy

2015 ◽  
Vol 58 (2) ◽  
pp. 159-171 ◽  
Author(s):  
Fraser McLean Smith ◽  
Christopher Rao ◽  
Rodrigo Oliva Perez ◽  
Krzysztof Bujko ◽  
Thanos Athanasiou ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Elderly Patients ◽  
Clinical Response ◽  
Neoadjuvant Therapy ◽  
Radical Surgery ◽  
Complete Clinical Response ◽  
Early Survival

scholarly journals Organ-Preserving Strategies for the Management of Near-Complete Responses in Rectal Cancer after Neoadjuvant Chemoradiation

2017 ◽  
Vol 30 (05) ◽  
pp. 395-403 ◽  
Author(s):  
Patricio Lynn ◽  
Paul Strombom ◽  
Julio Garcia-Aguilar
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Clinical Response ◽  
Neoadjuvant Therapy ◽  
Organ Preservation ◽  
Bowel Wall ◽  
Tumor Response ◽  
Complete Response ◽  
Mesorectal Excision ◽  
Term Survival

AbstractIn recent years, organ preservation has been considered a feasible alternative to total mesorectal excision for patients with locally advanced rectal cancer with a clinical complete response to neoadjuvant therapy. However, the degree of tumor response to neoadjuvant therapy is variable. A fraction of the patients who did not achieve a complete response had grossly visible tumors. These patients, with clearly incomplete clinical response, need a total mesorectal excision. In addition, some patients with a significant tumor response still have some abnormalities in the bowel wall, such as superficial ulceration or tissue nodularity, which, while not conclusive for the presence of a tumor, are indicative of the possibility of a residual tumor in the bowel wall or in mesorectal lymph nodes. The management of patients with a so-called near-complete clinical response to neoadjuvant therapy is controversial. In this article, we will review the clinical and radiological criteria that define a clinical response to neoadjuvant therapy, possible treatment strategies, and follow-up protocols. We will also discuss patient and tumor characteristics that in our opinion can be useful in selecting the most appropriate treatment alternative. Although organ preservation and quality of life are important, the primary goal of treatment for these patients should be local tumor control and long-term survival.

Nonoperative Management of Rectal Cancer With Complete Clinical Response After Neoadjuvant Therapy

2012 ◽  
Vol 256 (6) ◽  
pp. 965-972 ◽  
Author(s):  
James D. Smith ◽  
Jeannine A. Ruby ◽  
Karyn A. Goodman ◽  
Leonard B. Saltz ◽  
José G. Guillem ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Clinical Response ◽  
Neoadjuvant Therapy ◽  
Nonoperative Management ◽  
Complete Clinical Response
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