Selected stage IV rectal cancer patients managed by the watch-and-wait approach after pelvic radiotherapy: a good alternative to total mesorectal excision surgery?
the Dutch Watch-and-Wait Consortium (collaborators)
(2022) Colorectal Disease, volume 24, issue 4, pp. 401 - 410
(Article)
Abstract
Aim: The aim of this study was to assess the clinical and oncological outcome of a selected group of stage IV rectal cancer patients managed by the watch-and-wait approach following a (near-)complete response of the primary rectal tumour after radiotherapy. Method: Patients registered in the Dutch watch-and-wait registry since 2004
... read more
were selected when diagnosed with synchronous stage IV rectal cancer. Data on patient characteristics, treatment details, follow-up and survival were collected. The 2-year local regrowth rate, organ-preservation rate, colostomy-free rate, metastatic progression-free rate and 2- and 5-year overall survival were analysed. Results: After a median follow-up period of 35 months, local regrowth was observed in 17 patients (40.5%). Nine patients underwent subsequent total mesorectal excision, resulting in a permanent colostomy in four patients. The 2-year local regrowth rate was 39.9%, the 2-year organ-preservation rate was 77.1%, the 2-year colostomy-free rate was 88.1%, and the 2-year metastatic progression-free rate was 46.7%. The 2- and 5-year overall survival rates were 92.0% and 67.5%. Conclusion: The watch-and-wait approach can be considered as an alternative to total mesorectal excision in a selected group of stage IV rectal cancer patients with a (near-)complete response following pelvic radiotherapy. Despite a relatively high regrowth rate, total mesorectal excision and a permanent colostomy can be avoided in the majority of these patients.
show less
Download/Full Text
Keywords: metastatic disease, oncological outcome, organ-preservation, rectal cancer, watch-and-wait, Humans, Neoplasm Recurrence, Local, Neoadjuvant Therapy, Rectal Neoplasms/radiotherapy, Watchful Waiting, Chemoradiotherapy, Adjuvant, Gastroenterology, Journal Article
ISSN: 1462-8910
Publisher: Wiley-Blackwell
Note: Funding Information: There has been no financial support for this work. The authors thank the Dutch Watch-and-Wait Consortium (collaborators). Collaborators: Regina G. H. Beets-Tan, MD, PhD: Netherlands Cancer Institute, Department of Radiology, Amsterdam, The Netherlands; Jeroen Buijsen, MD, PhD: Maastricht University Medical Center, Department of Radiation Oncology (Maastro), Maastricht, The Netherlands and Maastricht University, GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands; Sebastiaan Festen, MD, PhD: Onze Lieve Vrouwe Gasthuis, Department of Surgery, Amsterdam, The Netherlands; Eelco J. R. de Graaf, MD, PhD: IJsselland Hospital, Department of Surgery, Capelle aan de IJssel, The Netherlands; Hester E. Haak, MD: Netherlands Cancer Institute, Department of Surgery, Amsterdam, The Netherlands; Denise E. Hilling, MD, PhD: Leiden University Medical Center, Department of Surgery, Leiden, The Netherlands and Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Oncological and Gastrointestinal Surgery, Rotterdam, The Netherlands; Christiaan Hoff, MD: Medical Center Leeuwarden, Department of Surgery, Leeuwarden, The Netherlands; Martijn Intven, MD, PhD: University Medical Center Utrecht, Department of Radiotherapy, Utrecht, The Netherlands; Niels Komen, MD, PhD: Antwerp University Hospital, Department of Abdominal Surgery, Edegem, Belgium and University of Antwerp, Antwerp Surgical Training, Anatomy and Research Center (ASTRAC), Wilrijk, Antwerp, Belgium; Miranda Kusters, MD, PhD: Amsterdam University Medical Centers, Location VUmc, Department of Surgery, Amsterdam, The Netherlands; Monique E. van Leerdam, MD, PhD: Netherlands Cancer Institute, Department of Gastroenterology, Amsterdam, The Netherlands and Leiden University Medical Center, Department of Gastroenterology, Leiden, The Netherlands; Koen C. M. J. Peeters, MD, PhD: Leiden University Medical Center, Department of Surgery, Leiden, The Netherlands; Femke P. Peters, MD, PhD: Netherlands Cancer Institute, Department of Radiotherapy, Amsterdam, The Netherlands and Leiden University Medical Center, Department of Radiotherapy, Leiden, The Netherlands; Apollo Pronk, MD, PhD: Diakonessenhuis, Department of Surgery, Utrecht, The Netherlands; Marit E. van der Sande, MD: Netherlands Cancer Institute, Department of Surgery, Amsterdam, The Netherlands; Wilhelmina. H. Schreurs, MD, PhD: Noordwest Ziekenhuisgroep, Department of Surgery, Alkmaar, The Netherlands; Dirk J. A. Sonneveld, MD, PhD: Dijklander Hospital, Department of Surgery, Hoorn, The Netherlands; Aalbert K. Talsma, MD, PhD: Deventer Hospital, Department of Surgery, Deventer, The Netherlands; Jurriaan B. Tuynman, MD, PhD: Amsterdam University Medical Centers, Location VUmc, Department of Surgery, Amsterdam, The Netherlands; Liselot B. J. Valkenburg-van Iersel, MD, PhD: Maastricht University Medical Center, Department of Internal Medicine, Division of Medical Oncology, Maastricht, The Netherlands and Maastricht University, GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands; Maarten Vermaas, MD, PhD: IJsselland Hospital, Department of Surgery, Capelle aan de IJssel, The Netherlands; Judith de Vos-Geelen, MD: Maastricht University Medical Center, Department of Internal Medicine, Division of Medical Oncology, Maastricht, The Netherlands and Maastricht University, GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands; Henderik L. van Westreenen, MD, PhD: Isala, Department of Surgery, Zwolle, The Netherlands; Johannes H. W. de Wilt, MD, PhD: Radboud University Medical Center, Department of Surgery, Nijmegen, The Netherlands; David D. E. Zimmerman, MD, PhD: Elisabeth TweeSteden Hospital, Department of Surgery, Tilburg, The Netherlands. Publisher Copyright: © 2022 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland. © 2022 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.
(Peer reviewed)
