Wait-and-see treatment strategies for rectal cancer patients with clinical complete response after neoadjuvant chemoradiotherapy: a systematic review and meta-analysis.

• 发表时间: Jul 2016 12
• 来源期刊: Oncotarget
• DOI: 10.18632/oncotarget.8622
• PMID: 27070085
• 文章类型: Journal Article
• 中科院分区: Q1
• 方向: 医学
• 作者列表: Li J,Li L,Yang L,Yuan J,Lv B,Yao Y,Xing S

关键词: clinical complete response; neoadjuvant chemoradiotherapy; rectal cancer; wait-and-see

Mesh: Chemoradiotherapy; Humans; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Rectal Neoplasms / pathology surgery therapy; Remission Induction; Risk Factors; Salvage Therapy; Survival Analysis; Watchful Waiting

Abstract

Wait-and-see treatment strategies may benefit rectal cancer patients who achieve a clinical complete response (cCR) after neoadjuvant chemoradiotherapy (NCRT). In this study, we analyzed data from 9 eligible trials to compare the oncologic outcomes of 251 rectal cancer patients achieving a cCR through nonsurgical management approaches with the outcomes of 344 patients achieving a pathologic complete response (pCR) through radical surgery. The two patient groups did not differ in distant metastasis rates or disease-free and overall survival, but the nonsurgical group had a higher risk of 1, 2, 3, and 5-year local recurrence. Hence, we concluded that for rectal cancer patients achieving a cCR after NCRT, a wait-and-see strategy with strict selection criteria, an appropriate follow-up schedule, and salvage treatments achieved outcomes at least as good as radical surgery. Long-term randomized and controlled trials with more uniform inclusion criteria and standardized follow-up schedules will help clarify the risks and benefits of wait-and-see treatment strategies for these patients.