Watch-and-wait strategy in rectal cancer: Is there a tumour size limit? Results from two pooled prospective studies
| Autor: | Iwona Gisterek, Marek Mazurek, Jolanta Szelachowska, Wojciech Zegarski, Marek Szczepkowski, Lucyna Pietrzak, Marek Bębenek, Joanna Reszke, Anna Z. Cencelewicz, Maciej Rupinski, Krzysztof Bujko, Malgorzata Jankiewicz, Joanna Socha, Wojciech Michalski, Michał Jankowski, Anna Hołdakowska, Andrzej Rutkowski, Piotr Richter, Wojciech Polkowski, Tomasz Olesiński, Roman Styliński, Krzysztof Małecki, Karol Paciorek, Przemysław Wawok |
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| Rok vydání: | 2021 |
| Předmět: |
Oncology
medicine.medical_specialty Preoperative radiotherapy Colorectal cancer 030218 nuclear medicine & medical imaging 03 medical and health sciences Mesorectal fascia 0302 clinical medicine Internal medicine Humans Medicine Radiology Nuclear Medicine and imaging In patient Prospective Studies Watchful Waiting Prospective cohort study Aged integumentary system Rectal Neoplasms business.industry Cancer Consolidation Chemotherapy Chemoradiotherapy Hematology medicine.disease Neoadjuvant Therapy Treatment Outcome Tumour size 030220 oncology & carcinogenesis Neoplasm Recurrence Local business |
| Zdroj: | Radiotherapy and Oncology. 160:229-235 |
| ISSN: | 0167-8140 |
| Popis: | Background Frequency and predictive factors for a clinical complete response (cCR) in unselected patients are unclear. Material and methods 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. |
| Databáze: | OpenAIRE |
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