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Techniques in Coloproctology
Erschienen in:

28.07.2017 | Original Article

Rectal sparing approach after preoperative radio- and/or chemotherapy (RESARCH) in patients with rectal cancer: a multicentre observational study

verfasst von: A. Barina, A. De Paoli, P. Delrio, M. Guerrieri, A. Muratore, F. Bianco, D. Vespa, C. Asteria, E. Morpurgo, A. Restivo, C. Coco, U. Pace, C. Belluco, C. Aschele, S. Lonardi, V. Valentini, G. Mantello, I. Maretto, P. Del Bianco, A. Perin, S. Pucciarelli

Erschienen in: Techniques in Coloproctology | Ausgabe 8/2017

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Abstract

Background

Rectum-sparing approaches appear to be appropriate in rectal cancer patients with a major (mCR) or complete clinical response (cCR) after neoadjuvant therapy. The aim of the present study is to evaluate the effectiveness of rectum-sparing approaches at 2 years after the completion of neoadjuvant treatment.

Study design

Patients with rectal adenocarcinoma eligible to receive neoadjuvant therapy will be prospectively enrolled. Patients will be restaged 7–8 weeks after the completion of neoadjuvant therapy and those with mCR (defined as absence of mass, small mucosal irregularity no more than 2 cm in diameter at endoscopy and no metastatic nodes at MRI) or cCR will be enrolled in the trial. Patients with mCR will undergo local excision, while patients with cCR will either undergo local excision or watch and wait policy. The main end point of the study is to determine the percentage of rectum preservation at 2 years in the enrolled patients.

Conclusion

This protocol is the first prospective trial that investigates the role of both local excision and watch and wait approaches in patients treated with neoadjuvant therapy for rectal cancer. The trial is registered at clinicaltrials.gov (NCT02710812).
Literatur
1.
Kapiteijn E, Marijnen CA, Nagtegaal ID et al (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345:638–646CrossRefPubMed
2.
Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740CrossRefPubMed
3.
Maas M, Nelemans PG, 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
4.
Pucciarelli S, Del Bianco P, Efficace F et al (2011) Patient-reported outcomes after neoadjuvant chemoradiotherapy for rectal cancer: a multicenter prospective observational study. Ann Surg 253:71–77CrossRefPubMed
5.
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
6.
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
7.
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 6:42354–42361CrossRefPubMedPubMedCentral
8.
Appelt AL, PIøen 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
9.
Martens MH, Maas M, Heijnen LA et al (2016) Long-term outcome of organ preservation in 100 clinical complete responders after neoadjuvant treatment for rectal cancer. J Natl Cancer Inst 10:108
10.
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
11.
Lezoche E, Baldarelli M, Lezoche G et al (2012) Randomized clinical trial of endoluminal locoregional resection versus laparoscopic total mesorectal excision for T2 rectal cancer after neoadjuvant therapy. Br J Surg 99:1211–1218CrossRefPubMed
12.
Bujko K, Richter P, Smith FM et al (2013) Preoperative radiotherapy and local excision of rectal cancer with immediate radical re-operation for poor responders: a prospective multicentre study. Radiother Oncol 106:198–205CrossRefPubMed
13.
Pucciarelli S, De Paoli A, Guerrieri M et al (2013) Local excision after preoperative chemoradiotherapy for rectal cancer: results of a multicencer phase II clinical trial. Dis Colon Rectum 56:1349–1356CrossRefPubMed
14.
Rullier P, Rouanet P, Tuech JJ et al (2017) Organ preservation for rectal cancer (GRECCAR 2): a prospective, randomised, open-label, multicentre, phase 3 trial. Lancet S0140–6736:31056–31057
15.
Verseveld M, de Graff EJ, Verhoef C et al (2015) Chemoradiation therapy for rectal cancer in the distal rectum followed by organ-sparing transanal endoscopic microsurgery (CARTS study). Br J Surg 102:853–860CrossRefPubMed
16.
Garcia-Aguilar J, Renfro LA, Chow OS et al (2015) Organ preservation for clinical T2N0 distal rectal cancer using neoadjuvant chemoradiotherapy an local excision (ACOSOG Z6041): results of an open-label, single-arm, multi-institutional, phase 2 trial. Lancet Oncol 16:1537–1546CrossRefPubMedPubMedCentral
17.
National Comprehensive Cancer Network (2016) NCCN clinical practice guideline in oncology: rectal cancer—version 1.2017. Last Accessed 26 Jan 2016
18.
Compton CC, Byrd DR, Garcia-Aguilar J et al (2009) AJCC cancer staging manual, 7th edn. Springer, New York
19.
Habr-Gama A, Perez RO, Wynn G et al (2010) Complete clinical response after neoadjuvant chemoradiation therapy for distal rectal cancer: characterization of clinical and endoscopic findings for standardization. Dis Colon Rectum 53:1692–1698CrossRefPubMed
20.
von Elm E, Altman DG, Egger M et al (2008) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61:344–349CrossRef
21.
Beets GL, Figueiredo NF, Beets-Tan RG (2017) Management of rectal cancer without radical resection. Annu Rev Med 68:11.1–11.4CrossRef
22.
Glynne-Jones R, Hughes R (2012) Critical appraisal of the ‘wait and see’ approach in rectal cancer for clinical complete responders after chemoradiation. Br J Surg 99:897–909CrossRefPubMed
23.
Smith FM, Wiland H, Mace A et al (2014) Clinical criteria underestimate complete pathological response in rectal cancer treated with neoadjuvant chemoradiotherapy. Dis Colon Rectum 57:311–315CrossRefPubMed
24.
Pucciarelli S, Giandomenico F, De Paoli A et al (2017) Bowel function and quality of life after local excision or total mesorectal excision following chemoradiotherapy for rectal cancer. Br J Surg 104:138–147CrossRefPubMed
25.
Kalady MF, de Campos-Lobato LF, Stocchi L et al (2009) Predictive factors of pathologic complete response after neoadjuvant chemoradiation for rectal cancer. Ann Surg 127:213–220
26.
Petrelli F, Sgroi G, Sarti E et al (2016) Increasing the interval between neoadjuvant chemoradiotherapy and surgery in rectal cancer: a meta-analysis of published studies. Ann Surg 263:458–464CrossRefPubMed
27.
Bhoday J, Smith F, Siddiqui MR et al (2016) Magnetic resonance tumor regression grade and residual mucosal abnormality as predictors for pathological complete response in rectal cancer postneoadjuvant chemoradiotherapy. Dis Colon Rectum 59:925–933CrossRefPubMed
28.
Hanly AM, Ryan EM, Rogers AC et al (2014) Multicenter evaluation of rectal cancer ReImaging pOst Neoadjuvant (MERRION) therapy. Ann Surg 259:723–727CrossRefPubMed
29.
Maretto I, Pomerri F, Pucciarelli S et al (2007) The potential of re-staging in the prediction of pathologic response after preoperative chemoradiotherapy for rectal cancer. Ann Surg Oncol 14:455–461CrossRefPubMed
30.
Barbaro B, Vitale R, Valentini V et al (2012) Diffusion-weighted magnetic resonance imaging in monitoring rectal cancer response to neoadjuvant chemoradiotherapy. Int J Radiat Oncol Biol Phys 83:594–599CrossRefPubMed
Metadaten
Titel
Rectal sparing approach after preoperative radio- and/or chemotherapy (RESARCH) in patients with rectal cancer: a multicentre observational study
verfasst von
A. Barina
A. De Paoli
P. Delrio
M. Guerrieri
A. Muratore
F. Bianco
D. Vespa
C. Asteria
E. Morpurgo
A. Restivo
C. Coco
U. Pace
C. Belluco
C. Aschele
S. Lonardi
V. Valentini
G. Mantello
I. Maretto
P. Del Bianco
A. Perin
S. Pucciarelli
Publikationsdatum
28.07.2017
Verlag
Springer International Publishing
Erschienen in
Techniques in Coloproctology / Ausgabe 8/2017
Print ISSN: 1123-6337
Elektronische ISSN: 1128-045X
DOI
https://doi.org/10.1007/s10151-017-1665-1

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