Nonoperative Approaches to Rectal Cancer: A Critical Evaluation
Section snippets
Complete Tumor Regression
Several factors have been implicated in the prediction of complete pathologic response development after neoadjuvant CRT. A review of phase II and III studies using different regimens of neoadjuvant CRT for rectal cancer identified several predictive factors of a complete pathologic response, including the dose of radiation therapy delivered, the method of 5-fluorouracil (5-FU) infusion, and the use of additional drugs to standard 5-FU–based regimens. After reviewing 71 studies with over 4,000
Tumor Response Assessment
The efforts in identifying patients with tumors undergoing complete regression are important because the achievement of such is associated with excellent oncologic outcomes. Additionally, alternative treatment strategies, other than radical total mesorectal excision, may suffice in these patients.16 A major obstacle is that complete pathologic response can only be determined after full pathologic examination of the resected specimen after TME. In this setting, response assessment of tumors
Authors' Experience
Between 1991 and 2009, 475 patients with distal rectal cancer were managed at 2 collaborating Institutions (University of São Paulo School of Medicine/Angelita and Joaquim Gama Institute). All patients were enrolled in this watch and wait strategy after achieving a complete clinical response. Here we present updated data from one of these instituions (Angelita and Joaquim Gama Institute and Hospital Alemão Oswaldo Cruz). In this experience, 173 patients with rectal cancers located no more than
Conclusions
The fact that a proportion of patients with distal rectal cancer may develop complete pathological and clinical response is one of the great advantages of a neoadjuvant CRT approach. The management of such patients remains highly controversial. The development of molecular and new radiologic tools may aid in the accurate clinical identification of such patients in the future. Currently, no immediate surgery may be considered as a safe alternative in highly selected patients using very stringent
References (37)
- et al.
Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): A multicentre, randomised trial
Lancet
(2009) - et al.
Tumor downstaging and sphincter preservation with preoperative chemoradiation in locally advanced rectal cancer: The M.D. Anderson Cancer Center experience
Int J Radiat Oncol Biol Phys
(1999) - et al.
Chemoradiotherapy for rectal cancer: An updated analysis of factors affecting pathological response
Clin Oncol R Coll Radiol
(2008) - et al.
Short-course preoperative radiotherapy with delayed surgery in rectal cancer—A retrospective study
Radiother Oncol
(2008) - et al.
Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: A pooled analysis of individual patient data
Lancet Oncol
(2010) - 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) - et al.
Assessing the predictive value of clinical complete response to neoadjuvant therapy for rectal cancer: An analysis of 488 patients
J Am Coll Surg
(2002) - et al.
Prediction of mesorectal nodal metastases after chemoradiation for rectal cancer: Results of a randomised trial: Implication for subsequent local excision
Radiother Oncol
(2005) - et al.
Accuracy of endorectal ultrasonography and computed tomography for restaging rectal cancer after preoperative chemoradiation
J Am Coll Surg
(2008) - et al.
Preoperative versus postoperative chemoradiotherapy for rectal cancer
N Engl J Med
(2004)
Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer
N Engl J Med
Postoperative complications following surgery for rectal cancer
Ann Surg
Low rectal cancer: Impact of radiation and chemotherapy on surgical treatment
Dis Colon Rectum
Enhanced tumorocidal effect of chemotherapy with preoperative radiotherapy for rectal cancer: Preliminary results—EORTC 22921
J Clin Oncol
Chemotherapy with preoperative radiotherapy in rectal cancer
N Engl J Med
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
Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer
Br J Surg
An interval >7 weeks between neoadjuvant therapy and surgery improves pathologic complete response and disease-free survival in patients with locally advanced rectal cancer
Ann Surg Oncol
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