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Chemo-Radiotherapy for Locally Advanced T3/T4 Rectal Cancer: What Should We Do with Complete Responders?

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Multidisciplinary Treatment of Colorectal Cancer

Abstract

A proportion of patients, who receive preoperative chemoradiation (CRT) for locally advanced (cT3, cT4, NX) rectal cancer, achieve a pathological complete response (pCR). Less frequently a complete clinical response (cCR) is observed prior to surgery. So support is growing for the concept of ‘waiting to see’ and not proceeding to radical surgery if a cCR is observed – particularly when a permanent stoma is planned. We aimed to evaluate how often cCR is achieved following CRT, the concordance with pCR and the outcome, if patients who achieve cCR are observed rather than proceed to radical surgery. The rationale and outcome of non-radical surgical approaches are discussed.

It remains uncertain whether the degree of response to chemoradiation in terms of cCR or pCR is a useful clinical endpoint. cCR is inconsistently defined and insufficiently robust with only partial concordance with pCR. Studies, which include T3 rectal cancer, are associated with high local recurrence rates after nonsurgical treatment. Few studies report long-term outcome after achievement of a cCR.

The rationale of a ‘wait-and-see policy’ relies on retrospective observations which do not support this policy as routine except in patients who are recognised to be unfit for or refuse radical surgery. The strategy of examining the histology of a local excision merits further investigation. We would therefore encourage careful observational studies in this setting.

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  1. Department of Radiotherapy, Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, Middlesex, UK

    Robert Glynne-Jones FRCR & Rob Hughes FRCR

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  1. Institute of Regional Health Science, University of Southern Denmark, Odense, Denmark

    Gunnar Baatrup

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Glynne-Jones, R., Hughes, R. (2015). Chemo-Radiotherapy for Locally Advanced T3/T4 Rectal Cancer: What Should We Do with Complete Responders?. In: Baatrup, G. (eds) Multidisciplinary Treatment of Colorectal Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-06142-9_16

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