Rectal cancer with complete clinical remission after chemoradiotherapy: resection or watch-and-wait?
Angenete E, Ekelund AC, Hermanson M, Larsson K, Strandell A, Svanberg T, Swartling T, Jivegård L
Record ID 32018011360
English
Authors' objectives:
Background
In patients with advanced rectal cancer, chemoradiotherapy is an established treatment to achieve tumour down staging/downsizing prior to surgery and to lower the risk of local recurrence. Approximately 10% of patients have complete clinical response (cCR), i.e. no detectable tumour, after treatment with
chemoradiotherapy. For this group of patients a “watch and wait” strategy (W&W) without early resection has been suggested. Rectal resection is associated with significant perioperative risks and complications but also long-term impaired quality of life by altered bowel function.
Objective
To study if it is possible to avoid surgery without compromising disease-free survival in adult patients with rectal cancer planned for curative resection who have had a clinical complete response after initial chemoradiotherapy.
Authors' results and conclusions:
There are only few non-randomised studies including a total of approximately 600 patients of a “watch and wait” strategy compared with surgery in patients with rectal cancer with cCR after chemoradiotherapy. In the studies, survival and the frequency of distant metastasis did not differ while there were more local
recurrences and less major complications after “watch and wait”, but the certainty of evidence is very low for all outcomes. More studies, particularly on the outcome HRQoL and with adequate follow-up, are needed.
Details
Project Status:
Completed
Year Published:
2017
URL for published report:
https://mellanarkiv-offentlig.vgregion.se/alfresco/s/archive/stream/public/v1/source/available/sofia/su4372-1728378332-331/native/2017_95%20HTA-rapport%20Rectal%20cancer.pdf
English language abstract:
An English language summary is available
Publication Type:
Full HTA
MeSH Terms
- Rectal Neoplasms
- Chemoradiotherapy
- Colorectal Surgery
- Watchful Waiting
Keywords
- Resection
- Watch and wait
Contact
Organisation Name:
The Regional Health Technology Assessment Centre
Contact Address:
The Regional Health Technology Assessment Centre, Region Vastra Gotaland, HTA-centrum, Roda Straket 8, Sahlgrenska Universitetssjukhuset, 413 45 GOTHENBORG, Sweden
Contact Name:
hta-centrum@vgregion.se
Contact Email:
hta-centrum@vgregion.se
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.