Wait and see approach for rectal cancer with a clinically complete response after neoadjuvant concurrent chemoradiotherapy

Hyun Jung Kim, Jin Ho Song, Hyeong Sik Ahn, Bong Hoi Choi, Hojin Jeong, Hoon Sik Choi, Yun Hee Lee, Ki Mun Kang, Bae Kwon Jeong

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Purpose: Rectal cancer patients with a pathological complete response (pCR) after neoadjuvant concurrent chemoradiotherapy (CCRT) have a better prognosis compared to those without a pCR. Therefore, the “Wait and See” (W&S) approach in those who achieved clinically complete response (cCR) after CCRT was introduced as an alternative modality to the total mesorectal excision (TME). The aim of this study was to compare the oncological outcomes between W&S and TME via meta-analysis. Methods: We performed a comprehensive literature search on January 14, 2016, using MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Web of Science, and Scopus. In addition, the references of all articles obtained were searched manually. The qualities of each study were assessed using the Newcastle-Ottawa quality assessment scale. The main outcomes were recurrence, disease-free survival (DFS), and overall survival (OS). We calculated the risk ratio (RR) and hazard ratio (HR) for the recurrence and survival rates, respectively. Results: The RR of patients whose initial recurrences was local recurrence (LR), distant metastasis (DM), LR + DM, or overall recurrences were 0.18, 1.00, 0.61, and 0.49, respectively. There was no heterogeneity in the results. The HR of DFS was 0.59 and indicated that DFS in the TME group was superior compared with that in the W&S group. The OS has no significant difference between the studies. Conclusions: Although the W&S approach seemed feasible for rectal cancer patients with a cCR after neoadjuvant CCRT, concrete evidence obtained in well-controlled randomized trials with a long-term follow-up is required to validate potential treatment options.

Original languageEnglish
Pages (from-to)723-727
Number of pages5
JournalInternational Journal of Colorectal Disease
Volume32
Issue number5
DOIs
Publication statusPublished - 2017 May 1

Keywords

  • Chemoradiotherapy
  • Mesorectal excision
  • Overall survival
  • Rectal cancer
  • Salvage therapy
  • Wait and see

ASJC Scopus subject areas

  • Gastroenterology

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