Angelita and Joaquim Gama Institute, São Paulo, Brazil; University of São Paulo School of Medicine, São Paulo, Brazil.
Angelita and Joaquim Gama Institute, São Paulo, Brazil; University of São Paulo School of Medicine, São Paulo, Brazil.
Int J Radiat Oncol Biol Phys. 2014 Mar 15;88(4):822-8. doi: 10.1016/j.ijrobp.2013.12.012. Epub 2014 Feb 1.
To review the risk of local recurrence and impact of salvage therapy after Watch and Wait for rectal cancer with complete clinical response (cCR) after chemoradiation therapy (CRT).
Patients with cT2-4N0-2M0 distal rectal cancer treated with CRT (50.4-54 Gy + 5-fluorouracil-based chemotherapy) and cCR at 8 weeks were included. Patients with cCR were enrolled in a strict follow-up program with no immediate surgery (Watch and Wait). Local recurrence-free survival was compared while taking into account Watch and Wait strategy alone and Watch and Wait plus salvage.
90 of 183 patients experienced cCR at initial assessment after CRT (49%). When early tumor regrowths (up to and including the initial 12 months of follow-up) and late recurrences were considered together, 28 patients (31%) experienced local recurrence (median follow-up time, 60 months). Of those, 26 patients underwent salvage therapy, and 2 patients were not amenable to salvage. In 4 patients, local re-recurrence developed after Watch and Wait plus salvage. The overall salvage rate for local recurrence was 93%. Local recurrence-free survival at 5 years was 69% (all local recurrences) and 94% (after salvage procedures). Thirteen patients (14%) experienced systemic recurrence. The 5-year cancer-specific overall survival and disease-free survival for all patients (including all recurrences) were 91% and 68%, respectively.
Local recurrence may develop in 31% of patients with initial cCR when early regrowths (≤ 12 months) and late recurrences are grouped together. More than half of these recurrences develop within 12 months of follow-up. Salvage therapy is possible in ≥ 90% of recurrences, leading to 94% local disease control, with 78% organ preservation.
回顾接受放化疗后完全临床缓解（cCR）的直肠癌患者采用观察等待策略（Watch and Wait）后的局部复发风险和挽救治疗的影响。
本研究纳入了接受放化疗（50.4-54 Gy+基于氟尿嘧啶的化疗）治疗后达到 cT2-4N0-2M0 低位直肠癌且在 8 周时达到 cCR 的患者。达到 cCR 的患者被纳入严格的随访方案中，暂不进行手术（Watch and Wait）。同时考虑 Watch and Wait 策略本身和 Watch and Wait 加挽救治疗对局部无复发生存率的影响。
在 CRT 后初始评估时，183 例患者中有 90 例（49%）达到 cCR。当早期肿瘤退缩（包括最初 12 个月的随访期）和晚期复发一起考虑时，28 例（31%）患者发生局部复发（中位随访时间 60 个月）。其中，26 例患者接受了挽救治疗，2 例患者不适合挽救治疗。在 4 例患者中，Watch and Wait 加挽救治疗后出现局部再复发。局部复发的总体挽救率为 93%。5 年局部无复发生存率为 69%（所有局部复发）和 94%（挽救治疗后）。13 例（14%）患者发生远处转移。所有患者（包括所有复发）的 5 年癌症特异性总生存率和无病生存率分别为 91%和 68%。
当将早期退缩（≤12 个月）和晚期复发一起分组时，初始 cCR 的患者中有 31%可能发生局部复发。超过一半的复发发生在随访 12 个月内。挽救治疗在≥90%的复发中是可行的，导致 94%的局部疾病控制，78%的器官保留。
