Skip to main content
Erschienen in: coloproctology 2/2017

05.01.2017 | Rektumkarzinom | Übersichten

Complete response nach Radiochemotherapie des Rektumkarzinoms – was tun?

verfasst von: PD Dr. med. D. Wilhelm, U. Nitsche, T. Vogel, K. P. Janssen, H. Friess

Erschienen in: coloproctology | Ausgabe 2/2017

Einloggen, um Zugang zu erhalten

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.
Literatur
1.
Zurück zum Zitat 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 240:711–717PubMedPubMedCentral 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 240:711–717PubMedPubMedCentral
2.
Zurück zum Zitat 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 16:919–927CrossRefPubMed 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 16:919–927CrossRefPubMed
3.
Zurück zum Zitat 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 30:769–774CrossRefPubMed 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 30:769–774CrossRefPubMed
4.
Zurück zum Zitat 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 41:1456–1463CrossRefPubMed 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 41:1456–1463CrossRefPubMed
5.
Zurück zum Zitat 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 29:4633–4640CrossRefPubMed 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 29:4633–4640CrossRefPubMed
6.
Zurück zum Zitat 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 6:42354–42361PubMedPubMedCentral 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 6:42354–42361PubMedPubMedCentral
7.
Zurück zum Zitat 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 263:458–464CrossRefPubMed 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 263:458–464CrossRefPubMed
8.
Zurück zum Zitat 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 88:822–828CrossRefPubMed 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 88:822–828CrossRefPubMed
9.
Zurück zum Zitat 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 50:2032–2039CrossRefPubMed 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 50:2032–2039CrossRefPubMed
10.
Zurück zum Zitat McKeown E, Nelson DW, Johnson EK et al (2014) Current approaches and challenges for monitoring treatment response in colon and rectal cancer. J Cancer 5:31–43CrossRefPubMedPubMedCentral McKeown E, Nelson DW, Johnson EK et al (2014) Current approaches and challenges for monitoring treatment response in colon and rectal cancer. J Cancer 5:31–43CrossRefPubMedPubMedCentral
11.
Zurück zum Zitat Williamson JS, Jones HG, Davies M et al (2014) Outcomes in locally advanced rectal cancer with highly selective preoperative chemoradiotherapy. Br J Surg 101:1290–1298CrossRefPubMed Williamson JS, Jones HG, Davies M et al (2014) Outcomes in locally advanced rectal cancer with highly selective preoperative chemoradiotherapy. Br J Surg 101:1290–1298CrossRefPubMed
12.
Zurück zum Zitat 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 16:979–989CrossRefPubMed 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 16:979–989CrossRefPubMed
13.
Zurück zum Zitat 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) 55:1392–1399CrossRef 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) 55:1392–1399CrossRef
14.
Zurück zum Zitat 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 13:579–588CrossRefPubMed 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 13:579–588CrossRefPubMed
15.
Zurück zum Zitat 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 17:174–183CrossRefPubMed 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 17:174–183CrossRefPubMed
16.
Zurück zum Zitat Sloothaak DA, Geijsen DE, van Leersum NJ et al (2013) Optimal time interval between neoadjuvant chemoradiotherapy and surgery for rectal cancer. Br J Surg 100:933–939CrossRefPubMed Sloothaak DA, Geijsen DE, van Leersum NJ et al (2013) Optimal time interval between neoadjuvant chemoradiotherapy and surgery for rectal cancer. Br J Surg 100:933–939CrossRefPubMed
17.
Zurück zum Zitat 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 37:1122–1128CrossRefPubMed 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 37:1122–1128CrossRefPubMed
18.
Zurück zum Zitat 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 89:20150328CrossRefPubMed 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 89:20150328CrossRefPubMed
19.
Zurück zum Zitat 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:e0153944CrossRefPubMedPubMedCentral 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:e0153944CrossRefPubMedPubMedCentral
20.
Zurück zum Zitat 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 17:748–761CrossRefPubMed 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 17:748–761CrossRefPubMed
21.
Zurück zum Zitat 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 194:131–135CrossRefPubMed 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 194:131–135CrossRefPubMed
22.
Zurück zum Zitat 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 40:3029–3034CrossRefPubMed 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 40:3029–3034CrossRefPubMed
23.
Zurück zum Zitat 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 260:734–743CrossRefPubMed 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 260:734–743CrossRefPubMed
24.
Zurück zum Zitat 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 17:849–861CrossRefPubMed 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 17:849–861CrossRefPubMed
25.
Zurück zum Zitat 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 48:1372–1377CrossRefPubMed 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 48:1372–1377CrossRefPubMed
26.
Zurück zum Zitat 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 56:1109–1117CrossRefPubMed 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 56:1109–1117CrossRefPubMed
27.
Zurück zum Zitat 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 59:255–263CrossRefPubMed 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 59:255–263CrossRefPubMed
28.
Zurück zum Zitat 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 20:25–32CrossRefPubMed 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 20:25–32CrossRefPubMed
29.
Zurück zum Zitat 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 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
30.
Zurück zum Zitat 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 14:291–295CrossRefPubMed 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 14:291–295CrossRefPubMed
31.
Zurück zum Zitat 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 57:592–601CrossRefPubMed 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 57:592–601CrossRefPubMed
32.
Zurück zum Zitat 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 11:835–844CrossRefPubMed 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 11:835–844CrossRefPubMed
33.
Zurück zum Zitat 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 48:1851–1857CrossRefPubMed 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 48:1851–1857CrossRefPubMed
34.
Zurück zum Zitat 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 18:1590–1598CrossRefPubMed 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 18:1590–1598CrossRefPubMed
35.
Zurück zum Zitat 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 53:163–168CrossRefPubMed 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 53:163–168CrossRefPubMed
36.
Zurück zum Zitat Bosch SL, Vermeer TA, West NP et al (2016) Clinicopathological characteristics predict lymph node metastases in ypT0-2 rectal cancer after chemoradiotherapy. Histopathology 69:839–848CrossRefPubMed Bosch SL, Vermeer TA, West NP et al (2016) Clinicopathological characteristics predict lymph node metastases in ypT0-2 rectal cancer after chemoradiotherapy. Histopathology 69:839–848CrossRefPubMed
37.
Zurück zum Zitat 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 21:11–17CrossRefPubMed 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 21:11–17CrossRefPubMed
38.
Zurück zum Zitat 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 253:711–719CrossRefPubMed 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 253:711–719CrossRefPubMed
39.
Zurück zum Zitat Smith JD, Ruby JA, Goodman KA et al (2012) Nonoperative management of rectal cancer with complete clinical response after neoadjuvant therapy. Ann Surg 256:965–972CrossRefPubMed Smith JD, Ruby JA, Goodman KA et al (2012) Nonoperative management of rectal cancer with complete clinical response after neoadjuvant therapy. Ann Surg 256:965–972CrossRefPubMed
40.
Zurück zum Zitat 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 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
41.
Zurück zum Zitat 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 7:44857–44870PubMedPubMedCentral 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 7:44857–44870PubMedPubMedCentral
42.
Zurück zum Zitat 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 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
43.
Zurück zum Zitat 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 17:441–447CrossRefPubMed 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 17:441–447CrossRefPubMed
44.
Zurück zum Zitat 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 18:3686–3693CrossRefPubMedPubMedCentral 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 18:3686–3693CrossRefPubMedPubMedCentral
45.
Zurück zum Zitat 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 7:55–70CrossRefPubMedPubMedCentral 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 7:55–70CrossRefPubMedPubMedCentral
46.
Zurück zum Zitat 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 34:1604–1608CrossRefPubMed 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 34:1604–1608CrossRefPubMed
47.
Zurück zum Zitat 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 59:264–269CrossRefPubMed 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 59:264–269CrossRefPubMed
48.
Zurück zum Zitat 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 15:184–190CrossRefPubMed 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 15:184–190CrossRefPubMed
49.
Zurück zum Zitat 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 16:957–966CrossRefPubMedPubMedCentral 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 16:957–966CrossRefPubMedPubMedCentral
50.
Zurück zum Zitat 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 16:200–207CrossRefPubMed 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 16:200–207CrossRefPubMed
51.
Zurück zum Zitat Bonjer HJ, Deijen CL, Haglind E, Group CIS (2015) A randomized trial of Laparoscopic versus open surgery for rectal cancer. N Engl J Med 373:194PubMed Bonjer HJ, Deijen CL, Haglind E, Group CIS (2015) A randomized trial of Laparoscopic versus open surgery for rectal cancer. N Engl J Med 373:194PubMed
Metadaten
Titel
Complete response nach Radiochemotherapie des Rektumkarzinoms – was tun?
verfasst von
PD Dr. med. D. Wilhelm
U. Nitsche
T. Vogel
K. P. Janssen
H. Friess
Publikationsdatum
05.01.2017
Verlag
Springer Medizin
Erschienen in
coloproctology / Ausgabe 2/2017
Print ISSN: 0174-2442
Elektronische ISSN: 1615-6730
DOI
https://doi.org/10.1007/s00053-016-0128-x

Weitere Artikel der Ausgabe 2/2017

coloproctology 2/2017 Zur Ausgabe

Mitteilungen des BCD und der DGK

Mitteilungen des BCD und der DGK

Passend zum Thema

ANZEIGE

Synergien nutzen gegen Tumore

Lungen- und Magentumore können dank Immuntherapien deutlich besser behandelt werden. Dennoch kommt es trotzdem weiterhin häufig zum Krankheitsprogress. Welche Therapieoptionen sich in der Zweitlinie am besten eignen, haben wir für Sie zusammengefasst.

ANZEIGE

Darmkrebsreihenuntersuchungen zeigen EU-weit Erfolge

In Europa haben viele Länder dem Darmkrebs mit Hilfe von Früherkennungsprogrammen den Kampf angesagt. Es gibt einen deutlichen Zusammenhang zwischen Inzidenz und Mortalität von Darmkrebs und der Zeitspanne seit Einführung von Reihenuntersuchungen.

ANZEIGE

GI-Tumore und die Rolle von Angiogenesehemmern

Content Hub

Entdecken Sie mit praxisrelevanten Patientenfällen, kompakten Studieninhalten, informativen Experteninterviews und weiteren spannenden Inhalten, wie Sie den vielseitigen Herausforderungen bei GI-Tumoren begegnen können. Hier erfahren Sie mehr! PP-RB-DE-2009