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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.

Local recurrence after complete clinical response and watch and wait in rectal cancer after neoadjuvant chemoradiation: impact of salvage therapy on local disease control.

Author information

1
Angelita and Joaquim Gama Institute, São Paulo, Brazil; University of São Paulo School of Medicine, São Paulo, Brazil. Electronic address: gamange@uol.com.br.
2
Angelita and Joaquim Gama Institute, São Paulo, Brazil; University of São Paulo School of Medicine, São Paulo, Brazil.
3
Angelita and Joaquim Gama Institute, São Paulo, Brazil; Colorectal Surgery Division, University of São Paulo School of Medicine, São Paulo, Brazil.
4
Angelita and Joaquim Gama Institute, São Paulo, Brazil.
5
Angelita and Joaquim Gama Institute, São Paulo, Brazil; Ludwig Institute for Cancer Research, São Paulo Branch.

Abstract

PURPOSE:

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).

METHODS AND MATERIALS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

PMID:
24495589
DOI:
10.1016/j.ijrobp.2013.12.012
[Indexed for MEDLINE]

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