Strode Matthew, Shah Rupen, Boland Patrick M, Francescutti Valerie A, Mangieri Christopher W, Attwood Kristopher, Nurkin Steven J
Roswell Park Cancer Institute, Elm and Carlton Street, Buffalo, NY, 14263, USA.
Dwight D. Eisenhower Army Medical Center, 100 Hospital Road Fort Gordon, GA, 30813, USA.
Surg Oncol. 2019 Mar;28:116-120. doi: 10.1016/j.suronc.2018.11.012. Epub 2018 Nov 13.
Nonoperative or "watch and wait" strategies have emerged as a potential option for patients with rectal cancer that obtain a complete clinic response (cCR) after neoadjuvant therapy. We sought to evaluate our patients that experienced a cCR and their outcomes after non-operative management.
We performed a retrospective review of patients at our center with rectal cancer from 2012 to 2016. We then identified patients that had a documented "complete clinical response" of their tumors after different neoadjuvant treatments and underwent non-operative management. Patients were followed on a surveillance schedule that included physical exam, endoscopy and imaging.
A total of 29 patients elected to undergo nonoperative management with a mean patient age of 67 years old. All patients were treated with neoadjuvant long course chemoradiotherapy. Seven patients were treated with initial induction chemotherapy followed by chemoradiation and 11 received consolidation chemotherapy. During a median follow-up of 27.6 months, there were 6 (21%) recurrences (1 = local, 1 = local and distant, 4 distant). Of the 6 total recurrences, 5 patients were candidates for salvage surgical resection.
Neoadjuvant treatment strategies may facilitate durable rates of cCR. Continued responses after these treatments could possibly enable more patients to undergo nonoperative management. We believe nonoperative management can be offered to patients seeking rectal preservation, but more research is required to select the appropriate patients. For those patients experiencing recurrence, the majority of patients can be salvaged surgically.
对于在新辅助治疗后获得完全临床缓解（cCR）的直肠癌患者，非手术或“观察等待”策略已成为一种潜在选择。我们试图评估经历cCR的患者及其非手术治疗后的结局。
我们对2012年至2016年在本中心接受治疗的直肠癌患者进行了回顾性研究。然后，我们确定了在接受不同新辅助治疗后肿瘤有记录的“完全临床缓解”并接受非手术治疗的患者。对患者进行包括体格检查、内镜检查和影像学检查在内的随访。
共有29例患者选择接受非手术治疗，患者平均年龄为67岁。所有患者均接受了新辅助长程放化疗。7例患者先接受诱导化疗，然后进行放化疗，11例接受巩固化疗。在中位随访27.6个月期间，有6例（21%）复发（1例为局部复发，1例为局部和远处复发，4例为远处复发）。在总共6例复发患者中，5例患者适合进行挽救性手术切除。
新辅助治疗策略可能有助于实现持久的cCR率。这些治疗后的持续缓解可能使更多患者能够接受非手术治疗。我们认为，可以为寻求保留直肠的患者提供非手术治疗，但需要更多研究来选择合适的患者。对于那些复发的患者，大多数患者可以通过手术挽救。
