Watch-and-wait strategy in rectal cancer: Is there a tumour size limit? Results from two pooled prospective studies.
Radiother Oncol
; 160: 229-235, 2021 07.
Article
em En
| MEDLINE
| ID: mdl-34023328
ABSTRACT
BACKGROUND:
Frequency and predictive factors for a clinical complete response (cCR) in unselected patients are unclear. MATERIAL ANDMETHODS:
Two prospective observational studies were designed and pooled to explore predictive factors for cCR. Both studies evaluated the watch-and-wait strategy in consecutive patients; the first single-institutional study in elderly with a small tumour, the second multi-institutional study in all the patients receiving standard of care preoperative radiotherapy.RESULTS:
Four hundred and ninety patients were analysed. Short-course radiotherapy alone, or with consolidation chemotherapy or chemoradiation was given to 40.6%, 40.2% and 19.2% of the patients, respectively. The median interval from the radiation start to the first tumour response assessment was 10.2 weeks for short-course radiation and 13.2 weeks for chemoradiation. Seventy-three patients had cCR and 71 underwent w&w with the median follow-up of 24 months. The regrowth rate was 26.8%. cCR rate was 39.0% for low-risk cancer (cT1-2N0), 16.8% for intermediate-risk (cT3 with unthreatened mesorectal fascia [MRF-] or cT2N+) and 5.4% for high-risk (cT4 or MRF+). In the multivariable analysis, tumour volume (or tumour length and circumferential extent) and cN status were significant predictors for cCR. In circular cancers or with a length ≥7 cm (n = 184), cCR rate was only 2.7%, sustained cCR 1.6% and the sensitivity of cCR diagnosis 23.1%. None of 27 patients with a tumour larger than 120 cm3 achieved cCR.CONCLUSIONS:
Considering watch-and-wait strategy is questionable in patients with circular tumours or with tumour length ≥7 cm.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Neoplasias Retais
/
Terapia Neoadjuvante
Tipo de estudo:
Observational_studies
/
Prognostic_studies
Limite:
Aged
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Humans
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article