Britt J P Hupkens1,2,3,4, Monique Maas5, Milou H Martens6, Marit E van der Sande7, Doenja M J Lambregts4, Stéphanie O Breukink1, Jarno Melenhorst1, Janneke B Houwers3, Christiaan Hoff8, Meindert N Sosef6, Jeroen W A Leijtens9, Maaike Berbee10, Regina G H Beets-Tan2,4, Geerard L Beets2,7. 1. Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands. 2. GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands. 3. Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands. 4. Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands. 5. Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands. moniquemaas@live.nl. 6. Department of Surgery, Zuyderland Medical Centre, Heerlen/Sittard, The Netherlands. 7. Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands. 8. Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, The Netherlands. 9. Department of Surgery, Laurentius Hospital, Roermond, The Netherlands. 10. Department of Radiotherapy, Maastro Clinic, Maastricht, The Netherlands.
Abstract
BACKGROUND: To assess whether extending the observation period in patients with a near clinical complete response (near cCR) after chemoradiation (CRT) leads to an impaired oncological outcome. METHODS: Patients who had a clinical complete response (cCR) 8-10 weeks after CRT restaging with magnetic resonance imaging and endoscopy were offered a watch-and-wait strategy (W&W1), while patients with a near cCR were offered to undergo local excision or a second restaging 6-12 weeks later. Patients who achieved a cCR at the second restaging were also offered a watch-and-wait strategy (W&W2). RESULTS: Overall, 102 patients with a cCR at the first restaging immediately entered the W&W1, while the remaining 68 patients had a near cCR: 19 patients underwent transanal endoscopic microsurgery and 49 patients opted for a second restaging. Additionally, 44/49 (90%) patients showed a cCR at the second restaging and entered the W&W2. Patients in the W&W1 group had a 2-year local regrowth-free rate (LRFR) of 84% and 2-year overall survival (OS) of 99%, while patients in the W&W2 group had a 2-year LRFR of 73% and OS of 98% (p > 0.05). Multivariable Cox regression analyses showed that late inclusion was not a significant predictive factor for higher risk of LR or lower non-regrowth disease-free survival. CONCLUSIONS: Overall, 90% of patients with a near cCR 8-10 weeks after CRT will proceed to a cCR 6-12 weeks later; therefore, it seems logical to extend the observation period rather than to proceed to surgery. Although there is a non-significant increase in local regrowth rate in these patients, it does not seem to impact the oncological outcome.
BACKGROUND: To assess whether extending the observation period in patients with a near clinical complete response (near cCR) after chemoradiation (CRT) leads to an impaired oncological outcome. METHODS:Patients who had a clinical complete response (cCR) 8-10 weeks after CRT restaging with magnetic resonance imaging and endoscopy were offered a watch-and-wait strategy (W&W1), while patients with a near cCR were offered to undergo local excision or a second restaging 6-12 weeks later. Patients who achieved a cCR at the second restaging were also offered a watch-and-wait strategy (W&W2). RESULTS: Overall, 102 patients with a cCR at the first restaging immediately entered the W&W1, while the remaining 68 patients had a near cCR: 19 patients underwent transanal endoscopic microsurgery and 49 patients opted for a second restaging. Additionally, 44/49 (90%) patients showed a cCR at the second restaging and entered the W&W2. Patients in the W&W1 group had a 2-year local regrowth-free rate (LRFR) of 84% and 2-year overall survival (OS) of 99%, while patients in the W&W2 group had a 2-year LRFR of 73% and OS of 98% (p > 0.05). Multivariable Cox regression analyses showed that late inclusion was not a significant predictive factor for higher risk of LR or lower non-regrowth disease-free survival. CONCLUSIONS: Overall, 90% of patients with a near cCR 8-10 weeks after CRT will proceed to a cCR 6-12 weeks later; therefore, it seems logical to extend the observation period rather than to proceed to surgery. Although there is a non-significant increase in local regrowth rate in these patients, it does not seem to impact the oncological outcome.
Authors: Philippe Bulens; Alice Couwenberg; Martijn Intven; Annelies Debucquoy; Vincent Vandecaveye; Eric Van Cutsem; André D'Hoore; Albert Wolthuis; Pritam Mukherjee; Olivier Gevaert; Karin Haustermans Journal: Radiother Oncol Date: 2019-08-17 Impact factor: 6.280
Authors: Barbara M Geubels; Vincent M Meyer; Henderik L van Westreenen; Geerard L Beets; Brechtje A Grotenhuis Journal: Cancers (Basel) Date: 2022-06-23 Impact factor: 6.575
Authors: Peter Mbanu; Mark P Saunders; Hitesh Mistry; Joe Mercer; Lee Malcomson; Saif Yousif; Gareth Price; Rohit Kochhar; Andrew G Renehan; Marcel van Herk; Eliana Vasquez Osorio Journal: Phys Imaging Radiat Oncol Date: 2022-06-28
Authors: Seth I Felder; Sebastian Feuerlein; Arthur Parsee; Iman Imanirad; Julian Sanchez; Sophie Dessureault; Richard Kim; Sarah Hoffe; Jessica Frakes; James Costello Journal: Abdom Radiol (NY) Date: 2020-10-28
Authors: Jin K Kim; Hannah Thompson; Rosa M Jimenez-Rodriguez; Fan Wu; Francisco Sanchez-Vega; Garrett M Nash; Jose G Guillem; Philip B Paty; Iris H Wei; Emmanouil P Pappou; Maria Widmar; Martin R Weiser; J Joshua Smith; Julio Garcia-Aguilar Journal: Ann Surg Oncol Date: 2021-10-03 Impact factor: 5.344