Qiao-Xuan Wang1, Rong Zhang2, Wei-Wei Xiao1, Shu Zhang1, Wei-Hu Wang3, Xiang-Bo Wan4, Yuan-Hong Gao5, Ming-Biao Wei4, Yong-Heng Li3, Hui Chang1, Wei-Hao Xie1, Li-Ren Li6, Pei-Rong Ding6, Gong Chen6, Zhi-Fan Zeng1. 1. Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China. 2. Department of Endoscopy, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China. 3. Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, People's Republic of China. 4. Department of Radiation Oncology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou, People's Republic of China. 5. Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China. gaoyh@sysucc.org.cn. 6. Department of Colorectal Surgery, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.
Abstract
BACKGROUND: The watch-and-wait strategy offers a non-invasive therapeutic alternative for rectal cancer patients who have achieved a clinical complete response (cCR) after chemoradiotherapy. This study aimed to investigate the long-term clinical outcomes of this strategy in comparation to surgical resection. METHODS: Stage II/III rectal adenocarcinoma patients who received neoadjuvant chemoradiotherapy and achieved a cCR were selected from the databases of three centers. cCR was evaluated by findings from digital rectal examination, colonoscopy, and radiographic images. Patients in whom the watch-and-wait strategy was adopted were matched with patients who underwent radical resection through 1:1 propensity score matching analyses. Survival was calculated and compared in the two groups using the Kaplan-Meier method with the log rank test. RESULTS: A total of 117 patients in whom the watch-and-wait strategy was adopted were matched with 354 patients who underwent radical resection. After matching, there were 94 patients in each group, and no significant differences in term of age, sex, T stage, N stage or tumor location were observed between the two groups. The median follow-up time was 38.2 months. Patients in whom the watch-and-wait strategy was adopted exhibited a higher rate of local recurrences (14.9% vs. 1.1%), but most (85.7%) were salvageable. Three-year non-regrowth local recurrence-free survival was comparable between the two groups (98% vs. 98%, P = 0.506), but the watch-and-wait group presented an obvious advantage in terms of sphincter preservation, especially in patients with a tumor located within 3 cm of the anal verge (89.7% vs. 41.2%, P < 0.001). Three-year distant metastasis-free survival (88% in the watch-and-wait group vs. 89% in the surgical group, P = 0.874), 3-year disease-specific survival (99% vs. 96%, P = 0.643) and overall survival (99% vs. 96%, P = 0.905) were also comparable between the two groups, although a higher rate (35.7%) of distant metastases was observed in patients who exhibited local regrowth in the watch-and-wait group. CONCLUSION: The watch-and-wait strategy was safe, with similar survival outcomes but a superior sphincter preservation rate as compared to surgery in rectal cancer patients achieving a cCR after neoadjuvant chemoradiotherapy, and could be offered as a promising conservative alternative to invasive radical surgery.
BACKGROUND: The watch-and-wait strategy offers a non-invasive therapeutic alternative for rectal cancerpatients who have achieved a clinical complete response (cCR) after chemoradiotherapy. This study aimed to investigate the long-term clinical outcomes of this strategy in comparation to surgical resection. METHODS: Stage II/III rectal adenocarcinomapatients who received neoadjuvant chemoradiotherapy and achieved a cCR were selected from the databases of three centers. cCR was evaluated by findings from digital rectal examination, colonoscopy, and radiographic images. Patients in whom the watch-and-wait strategy was adopted were matched with patients who underwent radical resection through 1:1 propensity score matching analyses. Survival was calculated and compared in the two groups using the Kaplan-Meier method with the log rank test. RESULTS: A total of 117 patients in whom the watch-and-wait strategy was adopted were matched with 354 patients who underwent radical resection. After matching, there were 94 patients in each group, and no significant differences in term of age, sex, T stage, N stage or tumor location were observed between the two groups. The median follow-up time was 38.2 months. Patients in whom the watch-and-wait strategy was adopted exhibited a higher rate of local recurrences (14.9% vs. 1.1%), but most (85.7%) were salvageable. Three-year non-regrowth local recurrence-free survival was comparable between the two groups (98% vs. 98%, P = 0.506), but the watch-and-wait group presented an obvious advantage in terms of sphincter preservation, especially in patients with a tumor located within 3 cm of the anal verge (89.7% vs. 41.2%, P < 0.001). Three-year distant metastasis-free survival (88% in the watch-and-wait group vs. 89% in the surgical group, P = 0.874), 3-year disease-specific survival (99% vs. 96%, P = 0.643) and overall survival (99% vs. 96%, P = 0.905) were also comparable between the two groups, although a higher rate (35.7%) of distant metastases was observed in patients who exhibited local regrowth in the watch-and-wait group. CONCLUSION: The watch-and-wait strategy was safe, with similar survival outcomes but a superior sphincter preservation rate as compared to surgery in rectal cancerpatients achieving a cCR after neoadjuvant chemoradiotherapy, and could be offered as a promising conservative alternative to invasive radical surgery.
Authors: Nicholas J Battersby; Peter How; Brendan Moran; Sigmar Stelzner; Nicholas P West; Graham Branagan; Joachim Strassburg; Philip Quirke; Paris Tekkis; Bodil Ginnerup Pedersen; Mark Gudgeon; Bill Heald; Gina Brown Journal: Ann Surg Date: 2016-04 Impact factor: 12.969
Authors: Maxime J M van der Valk; Denise E Hilling; Esther Bastiaannet; Elma Meershoek-Klein Kranenbarg; Geerard L Beets; Nuno L Figueiredo; Angelita Habr-Gama; Rodrigo O Perez; Andrew G Renehan; Cornelis J H van de Velde Journal: Lancet Date: 2018-06-23 Impact factor: 79.321
Authors: James D Smith; Jeannine A Ruby; Karyn A Goodman; Leonard B Saltz; José G Guillem; Martin R Weiser; Larissa K Temple; Garrett M Nash; Philip B Paty Journal: Ann Surg Date: 2012-12 Impact factor: 12.969
Authors: Al B Benson; Alan P Venook; Mahmoud M Al-Hawary; Lynette Cederquist; Yi-Jen Chen; Kristen K Ciombor; Stacey Cohen; Harry S Cooper; Dustin Deming; Paul F Engstrom; Jean L Grem; Axel Grothey; Howard S Hochster; Sarah Hoffe; Steven Hunt; Ahmed Kamel; Natalie Kirilcuk; Smitha Krishnamurthi; Wells A Messersmith; Jeffrey Meyerhardt; Mary F Mulcahy; James D Murphy; Steven Nurkin; Leonard Saltz; Sunil Sharma; David Shibata; John M Skibber; Constantinos T Sofocleous; Elena M Stoffel; Eden Stotsky-Himelfarb; Christopher G Willett; Evan Wuthrick; Kristina M Gregory; Lisa Gurski; Deborah A Freedman-Cass Journal: J Natl Compr Canc Netw Date: 2018-07 Impact factor: 11.908
Authors: R O Perez; A Habr-Gama; G V Pereira; P B Lynn; P A Alves; I Proscurshim; V Rawet; J Gama-Rodrigues Journal: Colorectal Dis Date: 2012-06 Impact factor: 3.788