Nonoperative versus operative approach according to the response to neoadjuvant chemoradiotherapy for rectal cancer: A prospective cohort study

•Watch-and-wait patients after chemoradiotherapy for rectal cancer have good functional outcome.•No survival differences were seen between patients undergoing surgery versus patients in a watch-and-wait protocol.•There is a subset of patients that has initial favorable response but will recur with d...

Full description

Saved in:

Bibliographic Details
Published in:	Clinical and translational radiation oncology Vol. 36; pp. 113 - 120
Main Authors:	Bulens, Philippe P., Smets, Lien, Debucquoy, Annelies, Joye, Ines, D'Hoore, André, Wolthuis, Albert, Debrun, Lynn, Dekervel, Jeroen, Van Cutsem, Eric, Dresen, Raphaëla, Vandecaveye, Vincent, Deroose, Christophe M., Sagaert, Xavier, Haustermans, Karin
Format:	Journal Article
Language:	English
Published:	Elsevier B.V 01-09-2022 Elsevier
Subjects:	Chemoradiotherapy Organ preservation Original Rectal cancer Watch-and-Wait Watch-and-Wait Organ preservation Rectal cancer Chemoradiotherapy
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	•Watch-and-wait patients after chemoradiotherapy for rectal cancer have good functional outcome.•No survival differences were seen between patients undergoing surgery versus patients in a watch-and-wait protocol.•There is a subset of patients that has initial favorable response but will recur with distant metastases afterwards.•A previously published model predicting (near)-complete response could not be validated. To report on organ preservation following chemoradiotherapy (CRT) in a prospective cohort of locally advanced rectal cancer patients. Fifty-two patients received CRT. MRI and 18F-FDG-PET/CT were performed prior to CRT. Response assessment was done 6 and 12 weeks after CRT using digital rectal examination, MRI, 18F-FDG-PET/CT and endoscopy. For clinical complete response or minimal residual disease, a watch-and-wait (W&W) protocol was started. Regrowth-free survival (ReFS), Total Mesorectal Excision-free disease-free survival, distant metastasis-free survival (DMFS) and overall survival (OS) were evaluated using Kaplan-Meier method. Functional outcome was compared with the Wilcoxon signed-rank test using EORTC QLQ-C30, MSKCC BFI, LARS and IIEF-5/FSFI-5 questionnaires. A previously developed prediction model performance was tested using receiver operating characteristic analysis. 29/52 patients entered a W&W protocol. There was no difference in two-year DMFS (81.1 % vs 78.8 %, p = 0.82), two-year OS (96.4 % vs 100 %, p = 0.38) and two-year DFS (77.5 % vs 78.8 %, p = 0.87) between W&W patients and those who underwent surgery at 12 weeks after CRT. Two-year DMFS differed between W&W with local regrowth, W&W with sustained response and patients who had surgery (66.7 % vs 88.0 % vs 78.8 %; p = 0.04). At 6 and 12 months, W&W patients reported good QoL and bowel function. The model validation reached an AUC of 0.627. Good functional outcome in patients with rectal cancer allocated to surveillance after CRT needs to be balanced against potentially worse DMFS in a subset of patients without sustained clinical complete response. Reliable prediction of patients eligible for surveillance programs needs further investigation.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Statistical Analysis.
ISSN:	2405-6308 2405-6308
DOI:	10.1016/j.ctro.2022.07.009