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Review
. 2017 Dec 28;3(1):47-53.
doi: 10.1515/iss-2017-0041. eCollection 2018 Mar.

Complete response after chemoradiotherapy for rectal cancer: what is the reasonable approach?

Affiliations
Review

Complete response after chemoradiotherapy for rectal cancer: what is the reasonable approach?

Claus Rödel et al. Innov Surg Sci. .

Abstract

With the increasing use of preoperative treatment rather than upfront surgery, it has become evident that the response of rectal carcinoma to standard chemoradiotherapy (CRT) shows a great variety that includes histopathologiocally confirmed complete tumor regression in 10-30% of cases. Adaptive strategies to avoid radical surgery, either by local excision or non-operative management, have been proposed in these highly responsive tumors. A growing number of prospective clinical trials and experiences from large databases, such as the European Registration of Cancer Care (EURECCA) watch-and-wait database, or the recent Oncological Outcome after Clinical Complete Response in Patients with Rectal Cancer (OnCoRe) project, will provide more information on its safety and efficacy, and help to select appropriate patients. Future studies will have to establish appropriate inclusion criteria and optimize CRT regimens in order to maximize the number of patients achieving complete response. Standardized re-staging procedures have to be investigated to improve the prediction of a sustained complete response, and long-term close follow-up with thorough documentation of failure patterns and salvage therapies will have to prove the oncological safety of this approach.

Keywords: chemoradiotherapy; complete response; local excision; non-operative management; rectal cancer; wait-and-see strategies.

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Figures

Figure 1:
Figure 1:
The TIMING Trial (Timing of Rectal Cancer Response to Chemoradiotherapy Trial) in locally advanced T3/4 and or N+ rectal cancer patients.
Figure 2:
Figure 2:
Trial schema of the MSKCC-based multicenter randomized phase II trial of induction chemotherapy versus consolidation chemotherapy with 5-FU/capecitabine and oxaliplatin before or after chemoradiotherapy in MRI-staged T2-3, N0, or Tany N1-2 rectal cancer (NOM, non operative management; TME, total mesorectal excision).

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References

    1. Sauer R, Liersch T, Merkel S, Fietkau R, Hohenberger W, Hess C, et al. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow up of 11 years. J Clin Oncol 2012;30:1926–33. - PubMed
    2. Sauer R, Liersch T, Merkel S, Fietkau R, Hohenberger W, Hess C. et al. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow up of 11 years. J Clin Oncol. 2012;30:1926–33. - PubMed
    1. van Gijn W, Marijnen CA, Nagtegaal ID, Kranenbarg EM-K, Putter H, Wiggers T, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol 2011;12:575–82. - PubMed
    2. van Gijn W, Marijnen CA, Nagtegaal ID, Kranenbarg EM-K, Putter H, Wiggers T. et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol. 2011;12:575–82. - PubMed
    1. Rödel C, Hofheinz RD, Fokas E. Rectal cancer: neoadjuvant chemoradiotherapy. Best Pract Res Clin Gastroenterol 2016;30:629–39. - PubMed
    2. Rödel C, Hofheinz RD, Fokas E. Rectal cancer: neoadjuvant chemoradiotherapy. Best Pract Res Clin Gastroenterol. 2016;30:629–39. - PubMed
    1. Fokas E, Liersch T, Fietkau R, Hohenberger W, Beissbarth T, Hess C, et al. Tumor regression grading after preoperative chemoradiotherapy for locally advanced rectal carcinoma revisited: updated results of the CAO/ARO/AIO-94 trial after a median follow-up of 11 years. J Clin Oncol 2014;32:1554–62. - PubMed
    2. Fokas E, Liersch T, Fietkau R, Hohenberger W, Beissbarth T, Hess C. et al. Tumor regression grading after preoperative chemoradiotherapy for locally advanced rectal carcinoma revisited: updated results of the CAO/ARO/AIO-94 trial after a median follow-up of 11 years. J Clin Oncol. 2014;32:1554–62. - PubMed
    1. Borschitz T, Wachtlin D, Möhler M, Schmidberger H, Junginger T. Neoadjuvant chemoradiation and local excision for T2-3 rectal cancer. Ann Surg Oncol 2008;15:712–20. - PubMed
    2. Borschitz T, Wachtlin D, Möhler M, Schmidberger H, Junginger T. Neoadjuvant chemoradiation and local excision for T2-3 rectal cancer. Ann Surg Oncol. 2008;15:712–20. - PubMed