Feasibility study of a Response Surveillance Program in locally advanced mid and low rectal cancer to increase organ preservation |
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| Institution: | 1. Department of Colorectal Surgery, CHU, Bordeaux, France;2. Department of Radiation Oncology, CHU, Bordeaux, France;3. Department of Radiology, CHU, Bordeaux, France;1. Servicio de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, España;2. Servicio de Oncología Médica, Hospital Universitario Ramón y Cajal, Madrid, España;1. Department of GI Surgery, Ghent University Hospital, Ghent, Belgium;2. Cancer Research Institute Ghent (CRIG), Belgium;1. Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, UK;2. Abertawe Bro Morgannwg University Health Board, UK;3. Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK;4. Department of Digestive Surgery, Colorectal Unit, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France;5. Department of Colorectal Surgery, Cambridge University Hospitals, Cambridge, UK;6. Department of Surgery, St Mark''s Hospital, Watford Road, Harrow, UK;1. Division of Thoracic Surgery, University Health Network, Toronto, ON, Canada;2. Department of Surgery, University of Toronto, Toronto, ON, Canada;3. Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland;1. Angelita & Joaquim Gama Institute, Rua Manoel da Nobrega, 1564, Sao Paulo, SP, 04001-005, Brazil;2. University of São Paulo School of Medicine, Colorectal Surgery Division, Av. Dr. Arnaldo, 455, Sao Paulo, SP, 01246-903, Brazil;3. Ludwig Institute for Cancer Research São Paulo Branch, Rua Dona Adma Jafet, 91, Sao Paulo, SP, 01308-050, Brazil;4. Hospital Alemão Oswaldo Cruz – Radiation Oncology, Rua Joao Juliao, 331, Sao Paulo, SP, 01323-020, Brazil;5. Centro de Oncologia Molecular – Hospital Sirio-Libanês, Rua Dona Adma Jafet, 91, Sao Paulo, SP, 01308-050, Brazil;6. Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sao Paulo, SP, 05652-900, Brazil;1. Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom;2. Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK;3. Department of Surgery & Cancer, Imperial College London, London, United Kingdom;4. Department of Molecular Medicine & Surgery, Karolinska Institutet, Stockholm, Sweden;5. Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle University Trust Hospitals, Newcastle-Upon-Tyne, United Kingdom;6. School of Medical Education, Newcastle University, Newcastle Upon Tyne, Tyne and Wear, United Kingdom;7. Department of Clinical Oncology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom;8. Department of General Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA;9. Edward-Elmhurst Health, Department of Surgical Oncology, Naperville, IL, USA |
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| Abstract: | BackgroundAssessment of tumor response in rectal cancer after neoadjuvant treatment by MRI (Tumour Regression Grade, TRG 1–5) is well standardized. The overall timing and method of defining complete response (cCR) remain controversial. The aim of this work was to evaluate the feasibility of a defined Response Surveillance Program (RSP) to increase organ preservation for locally advanced rectal cancer after neoadjuvant treatment.MethodsA standardized program of clinical (CR), radiological (RR) and metabolic (MR) assessment of tumor response is defined over a 6 month period from completion of NACRT with formal assessment performed every 2 months (M). Patients with TRG1-3 at M2 and TRG1-2 at M4 continue in the program up to M6 assessment. Patients managed with this protocol from 2016 to 2020 were analyzed. The primary endpoint was rectal preservation rate. Secondary endpoints included disease-free survival and overall survival at 3 years.Result314 potentially suitable patients were enrolled in the RSP and 50 patients completed the six month program and were successfully enrolled into watch and wait. Fourteen (28%) were T2 tumor stage, 27 (54%) T3 and nine (18%) were T4. During watch and wait, patients with locoregional recurrence (n = 11) were treated with local excision (n = 3), endocavitary radiotherapy (n = 1), TME (n = 5) and APR (n = 2). With a median follow-up of 32 months, the rectal preservation rate was 88%, with a 3-year disease-free survival of 67% and an overall survival of 98%.ConclusionThis study validates the feasibility of the practical implementation of a Response Surveillance Program to increase organ preservation rates without compromising oncological outcomes in rectal cancer. |
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| Keywords: | Rectal cancer Organ preservation Watch and wait Response assessment Complete response Neoadjuvant therapy |
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