Skip to main content

Advertisement

SpringerLink
Log in

Complete response nach Radiochemotherapie des Rektumkarzinoms – was tun?

Complete response after radiochemotherapy for rectal cancer – what to do?

  • Übersichten
  • Published:
coloproctology Aims and scope

Zusammenfassung

Die alleinige Beobachtung im Fall einer klinischen kompletten Tumorregression (cCR) nach neoadjuvanter Radiochemotherapie des Rektumkarzinoms wird zunehmend diskutiert. Grund hierfür sind Fallserien, die über lokale und systemische Tumorkontrollen berichten, die denen nach radikaler Chirurgie nahezu ebenbürtig sind, ohne das Risiko eines operativen Eingriffs oder einer permanenten Kolostomie zu beinhalten. Die vorliegende Arbeit ist bemüht, auf dem Boden der aktuellen Datenlage das Watch-and-wait-Konzept kritisch zu bewerten und in seiner Bedeutung gegenüber gängigen Methoden zu beurteilen.

Abstract

A watch-and-wait policy in case of complete clinical response following radiochemotherapy for rectal cancer is currently discussed. Reason for the debate are some case series which showed local and systemic recurrence rates that were rated equal to those after radical surgical resection while avoiding the risk for surgery-related complications and permanent colostomy. The aim of this article is to critically review this concept on the grounds of recent publications and to compare the results to standard treatment concepts.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Habr-Gama A, Perez RO, Nadalin W et al (2004) Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results. Ann Surg 240:711–717

    PubMed  PubMed Central  Google Scholar 

  2. Appelt AL, Ploen J, Harling H et al (2015) High-dose chemoradiotherapy and watchful waiting for distal rectal cancer: A prospective observational study. Lancet Oncol 16:919–927

    Article  PubMed  Google Scholar 

  3. Smith RK, Fry RD, Mahmoud NN, Paulson EC (2015) Surveillance after neoadjuvant therapy in advanced rectal cancer with complete clinical response can have comparable outcomes to total mesorectal excision. Int J Colorectal Dis 30:769–774

    Article  PubMed  Google Scholar 

  4. Araujo RO, Valadao M, Borges D et al (2015) Nonoperative management of rectal cancer after chemoradiation opposed to resection after complete clinical response. A comparative study. Eur J Surg Oncol 41:1456–1463

    Article  CAS  PubMed  Google Scholar 

  5. Maas M, Beets-Tan RG, Lambregts DM et al (2011) Wait-and-see policy for clinical complete responders after chemoradiation for rectal cancer. J Clin Oncol 29:4633–4640

    Article  PubMed  Google Scholar 

  6. Li J, Liu H, Yin J et al (2015) Wait-and-see or radical surgery for rectal cancer patients with a clinical complete response after neoadjuvant chemoradiotherapy: a cohort study. Oncotarget 6:42354–42361

    PubMed  PubMed Central  Google Scholar 

  7. Petrelli F, Sgroi G, Sarti E, Barni S (2016) Increasing the interval between Neoadjuvant Chemoradiotherapy and surgery in rectal cancer: A Meta-analysis of published studies. Ann Surg 263:458–464

    Article  PubMed  Google Scholar 

  8. Habr-Gama A, Gama-Rodrigues J, Sao Juliao GP et al (2014) Local recurrence after complete clinical response and watch and wait in rectal cancer after neoadjuvant chemoradiation: Impact of salvage therapy on local disease control. Int J Radiat Oncol Biol Phys 88:822–828

    Article  PubMed  Google Scholar 

  9. Lim L, Chao M, Shapiro J et al (2007) Long-term outcomes of patients with localized rectal cancer treated with chemoradiation or radiotherapy alone because of medical inoperability or patient refusal. Dis Colon Rectum 50:2032–2039

    Article  CAS  PubMed  Google Scholar 

  10. McKeown E, Nelson DW, Johnson EK et al (2014) Current approaches and challenges for monitoring treatment response in colon and rectal cancer. J Cancer 5:31–43

    Article  PubMed  PubMed Central  Google Scholar 

  11. Williamson JS, Jones HG, Davies M et al (2014) Outcomes in locally advanced rectal cancer with highly selective preoperative chemoradiotherapy. Br J Surg 101:1290–1298

    Article  CAS  PubMed  Google Scholar 

  12. Rodel C, Graeven U, Fietkau R et al (2015) Oxaliplatin added to fluorouracil-based preoperative chemoradiotherapy and postoperative chemotherapy of locally advanced rectal cancer (the German CAO/ARO/AIO-04 study): Final results of the multicentre, open-label, randomised, phase 3 trial. Lancet Oncol 16:979–989

    Article  PubMed  Google Scholar 

  13. Hall MD, Schultheiss TE, Smith DD, Fakih MG, Wong JY, Chen YJ (2016) Effect of increasing radiation dose on pathologic complete response in rectal cancer patients treated with neoadjuvant chemoradiation therapy. Acta Oncol (Madr) 55:1392–1399

    Article  CAS  Google Scholar 

  14. Hofheinz RD, Wenz F, Post S et al (2012) Chemoradiotherapy with capecitabine versus fluorouracil for locally advanced rectal cancer: A randomised, multicentre, non-inferiority, phase 3 trial. Lancet Oncol 13:579–588

    Article  CAS  PubMed  Google Scholar 

  15. Renehan AG, Malcomson L, Emsley R et al (2016) Watch-and-wait approach versus surgical resection after chemoradiotherapy for patients with rectal cancer (the OnCoRe project): A propensity-score matched cohort analysis. Lancet Oncol 17:174–183

    Article  PubMed  Google Scholar 

  16. Sloothaak DA, Geijsen DE, van Leersum NJ et al (2013) Optimal time interval between neoadjuvant chemoradiotherapy and surgery for rectal cancer. Br J Surg 100:933–939

    Article  CAS  PubMed  Google Scholar 

  17. Ptok H, Ruppert R, Stassburg J et al (2013) Pretherapeutic MRI for decision-making regarding selective neoadjuvant radiochemotherapy for rectal carcinoma: interim analysis of a multicentric prospective observational study. J Magn Reson Imaging 37:1122–1128

    Article  PubMed  Google Scholar 

  18. Sathyakumar K, Chandramohan A, Masih D, Jesudasan MR, Pulimood A, Eapen A (2016) Best MRI predictors of complete response to neoadjuvant chemoradiation in locally advanced rectal cancer. Br J Radiol 89:20150328

    Article  PubMed  Google Scholar 

  19. Chen YG, Chen MQ, Guo YY, Li SC, Wu JX, Xu BH (2016) Apparent diffusion coefficient predicts pathology complete response of rectal cancer treated with Neoadjuvant Chemoradiotherapy. PLOS ONE 11:e0153944

    Article  PubMed  PubMed Central  Google Scholar 

  20. Memon S, Lynch AC, Bressel M, Wise AG, Heriot AG (2015) Systematic review and meta-analysis of the accuracy of MRI and endorectal ultrasound in the restaging and response assessment of rectal cancer following neoadjuvant therapy. Colorectal Dis 17:748–761

    Article  CAS  PubMed  Google Scholar 

  21. Hiotis SP, Weber SM, Cohen AM et al (2002) Assessing the predictive value of clinical complete response to neoadjuvant therapy for rectal cancer: An analysis of 488 patients. J Am Coll Surg 194:131–135

    Article  PubMed  Google Scholar 

  22. Lim SG, Kim YB, Oh SY (2016) Clinical significance of the endoscopic finding in predicting complete tumor response to preoperative Chemoradiation therapy in rectal cancer. World J Surg 40:3029–3034

    Article  PubMed  Google Scholar 

  23. Curvo-Semedo L, Lambregts DM, Maas M et al (2011) Rectal cancer: assessment of complete response to preoperative combined radiation therapy with chemotherapy – conventional MR volumetry versus diffusion-weighted MR imaging. Radiology 260:734–743

    Article  PubMed  Google Scholar 

  24. Ryan JE, Warrier SK, Lynch AC, Heriot AG (2015) Assessing pathological complete response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer: A systematic review. Colorectal Dis 17:849–861

    Article  CAS  PubMed  Google Scholar 

  25. Sanchez Loria F, Iseas S, O’Connor JM et al (2016) Non-surgical management of rectal cancer. Series of 68 cases, long follow up in two leading centres in Argentina. Dig Liver Dis 48:1372–1377

    Article  PubMed  Google Scholar 

  26. Habr-Gama A, Sabbaga J, Gama-Rodrigues J et al (2013) Watch and wait approach following extended neoadjuvant chemoradiation for distal rectal cancer: Are we getting closer to anal cancer management? Dis Colon Rectum 56:1109–1117

    Article  PubMed  Google Scholar 

  27. Nahas SC, Rizkallah Nahas CS, Sparapan Marques CF et al (2016) Pathologic complete response in rectal cancer: Can we detect it? Lessons learned from a proposed randomized trial of watch-and-wait treatment of rectal cancer. Dis Colon Rectum 59:255–263

    Article  PubMed  Google Scholar 

  28. Kreis ME, Ruppert R, Ptok H et al (2016) Use of preoperative magnetic resonance imaging to select patients with rectal cancer for Neoadjuvant Chemoradiation – Interim analysis of the German OCUM trial (NCT01325649). J Gastrointest Surg 20:25–32

    Article  PubMed  Google Scholar 

  29. Lefevre JH, Mineur L, Kotti S et al (2016) Effect of interval (7 or 11 weeks) between Neoadjuvant Radiochemotherapy and surgery on complete pathologic response in rectal cancer: A Multicenter, randomized, controlled trial (GRECCAR-6). J Clin Oncol. doi:10.1200/JCO.2016.67.6049

    PubMed  Google Scholar 

  30. Armstrong D, Raissouni S, Price Hiller J et al (2015) Predictors of pathologic complete response after Neoadjuvant treatment for rectal cancer: A Multicenter study. Clin Colorectal Cancer 14:291–295

    Article  PubMed  Google Scholar 

  31. Hur H, Kim NK, Min BS et al (2014) Can a biomarker-based scoring system predict pathologic complete response after preoperative chemoradiotherapy for rectal cancer? Dis Colon Rectum 57:592–601

    Article  PubMed  Google Scholar 

  32. Maas M, Nelemans PJ, Valentini V et al (2010) Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: A pooled analysis of individual patient data. Lancet Oncol 11:835–844

    Article  PubMed  Google Scholar 

  33. Gavioli M, Luppi G, Losi L et al (2005) Incidence and clinical impact of sterilized disease and minimal residual disease after preoperative radiochemotherapy for rectal cancer. Dis Colon Rectum 48:1851–1857

    Article  PubMed  Google Scholar 

  34. de Campos-Lobato LF, Stocchi L, da Luz Moreira A et al (2011) Pathologic complete response after neoadjuvant treatment for rectal cancer decreases distant recurrence and could eradicate local recurrence. Ann Surg Oncol 18:1590–1598

    Article  PubMed  Google Scholar 

  35. Andrade VA, Coy CS, Leal RF, Fagundes JJ, Martinez CA, Ayrizono Mde L (2016) Neoadjuvant therapy and surgery for rectal cancer. Comparative study between partial and complete pathological response. Arq Gastroenterol 53:163–168

    Article  PubMed  Google Scholar 

  36. Bosch SL, Vermeer TA, West NP et al (2016) Clinicopathological characteristics predict lymph node metastases in ypT0-2 rectal cancer after chemoradiotherapy. Histopathology 69:839–848

    Article  PubMed  Google Scholar 

  37. Hughes R, Glynne-Jones R, Grainger J et al (2006) Can pathological complete response in the primary tumour following pre-operative pelvic chemoradiotherapy for T3-T4 rectal cancer predict for sterilisation of pelvic lymph nodes, a low risk of local recurrence and the appropriateness of local excision? Int J Colorectal Dis 21:11–17

    Article  CAS  PubMed  Google Scholar 

  38. Taylor FG, Quirke P, Heald RJ et al (2011) Preoperative high-resolution magnetic resonance imaging can identify good prognosis stage I, II, and III rectal cancer best managed by surgery alone: A prospective, multicenter, European study. Ann Surg 253:711–719

    Article  PubMed  Google Scholar 

  39. Smith JD, Ruby JA, Goodman KA et al (2012) Nonoperative management of rectal cancer with complete clinical response after neoadjuvant therapy. Ann Surg 256:965–972

    Article  PubMed  Google Scholar 

  40. Martens MH, Maas M, Heijnen LA et al (2016) Long-term outcome of an organ preservation program after Neoadjuvant treatment for rectal cancer. J Natl Cancer Inst 108(12). doi:10.1093/jnci/djw171

    Google Scholar 

  41. Li J, Li L, Yang L et al (2016) Wait-and-see treatment strategies for rectal cancer patients with clinical complete response after neoadjuvant chemoradiotherapy: a systematic review and meta-analysis. Oncotarget 7:44857–44870

    PubMed  PubMed Central  Google Scholar 

  42. Kim HJ, Song JH, Ahn HS et al (2016) Wait and see approach for rectal cancer with a clinically complete response after neoadjuvant concurrent chemoradiotherapy. Int J Colorectal Dis. doi:10.1007/s00384-016-2709-0

    Google Scholar 

  43. Callender GG, Das P, Rodriguez-Bigas MA et al (2010) Local excision after preoperative chemoradiation results in an equivalent outcome to total mesorectal excision in selected patients with T3 rectal cancer. Ann Surg Oncol 17:441–447

    Article  PubMed  Google Scholar 

  44. Belluco C, De Paoli A, Canzonieri V et al (2011) Long-term outcome of patients with complete pathologic response after neoadjuvant chemoradiation for cT3 rectal cancer: Implications for local excision surgical strategies. Ann Surg Oncol 18:3686–3693

    Article  PubMed  PubMed Central  Google Scholar 

  45. Dimitriou N, Michail O, Moris D, Griniatsos J (2015) Low rectal cancer: Sphincter preserving techniques-selection of patients, techniques and outcomes. World J Gastrointest Oncol 7:55–70

    Article  PubMed  PubMed Central  Google Scholar 

  46. Walega P, Kenig J, Richter P, Nowak W (2010) Functional and clinical results of transanal endoscopic microsurgery combined with endoscopic posterior mesorectum resection for the treatment of patients with t1 rectal cancer. World J Surg 34:1604–1608

    Article  PubMed  Google Scholar 

  47. Habr-Gama A, Lynn PB, Jorge JM et al (2016) Impact of organ-preserving strategies on Anorectal function in patients with distal rectal cancer following Neoadjuvant Chemoradiation. Dis Colon Rectum 59:264–269

    Article  PubMed  Google Scholar 

  48. Bosset JF, Calais G, Mineur L et al (2014) Fluorouracil-based adjuvant chemotherapy after preoperative chemoradiotherapy in rectal cancer: Long-term results of the EORTC 22921 randomised study. Lancet Oncol 15:184–190

    Article  CAS  PubMed  Google Scholar 

  49. Garcia-Aguilar J, Chow OS, Smith DD et al (2015) Effect of adding mFOLFOX6 after neoadjuvant chemoradiation in locally advanced rectal cancer: A multicentre, phase 2 trial. Lancet Oncol 16:957–966

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Breugom AJ, Swets M, Bosset JF et al (2015) Adjuvant chemotherapy after preoperative (chemo)radiotherapy and surgery for patients with rectal cancer: A systematic review and meta-analysis of individual patient data. Lancet Oncol 16:200–207

    Article  CAS  PubMed  Google Scholar 

  51. Bonjer HJ, Deijen CL, Haglind E, Group CIS (2015) A randomized trial of Laparoscopic versus open surgery for rectal cancer. N Engl J Med 373:194

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland

    D. Wilhelm, U. Nitsche, T. Vogel, K. P. Janssen & H. Friess

Authors
  1. D. Wilhelm
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. U. Nitsche
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. T. Vogel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. K. P. Janssen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H. Friess
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. Wilhelm.

Ethics declarations

Interessenkonflikt

D. Wilhelm, U. Nitsche, T. Vogel, K.P. Janssen und H. Friess geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wilhelm, D., Nitsche, U., Vogel, T. et al. Complete response nach Radiochemotherapie des Rektumkarzinoms – was tun?. coloproctology 39, 88–93 (2017). https://doi.org/10.1007/s00053-016-0128-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00053-016-0128-x

Schlüsselwörter

Keywords

Search

Navigation