TY - JOUR
T1 - Selected stage IV rectal cancer patients managed by the watch-and-wait approach after pelvic radiotherapy
T2 - a good alternative to total mesorectal excision surgery?
AU - Custers, Petra A.
AU - Hupkens, Britt J.P.
AU - the Dutch Watch-and-Wait Consortium
AU - Grotenhuis, Brechtje A.
AU - Kuhlmann, Koert F.D.
AU - Breukink, Stéphanie O.
AU - Beets, Geerard L.
AU - Melenhorst, Jarno
AU - Beets-Tan, Regina G.H.
AU - Buijsen, Jeroen
AU - Festen, Sebastiaan
AU - de Graaf, Eelco J.R.
AU - Haak, Hester E.
AU - Hilling, Denise E.
AU - Hoff, Christiaan
AU - Intven, Martijn
AU - Komen, Niels
AU - Kusters, Miranda
AU - van Leerdam, Monique E.
AU - Peeters, Koen C.M.J.
AU - Peters, Femke P.
AU - Pronk, Apollo
AU - van der Sande, Marit E.
AU - Schreurs, Wilhelmina H.
AU - Sonneveld, Dirk J.A.
AU - Talsma, Aalbert K.
AU - Tuynman, Jurriaan B.
AU - Valkenburg-van Iersel, Liselot B.J.
AU - Vermaas, Maarten
AU - de Vos-Geelen, Judith
AU - van Westreenen, Henderik L.
AU - de Wilt, Johannes H.W.
AU - Zimmerman, David D.E.
N1 - Publisher Copyright:
© 2022 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.
PY - 2022/4
Y1 - 2022/4
N2 - 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 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.
AB - 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 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.
UR - http://www.scopus.com/inward/record.url?scp=85126925301&partnerID=8YFLogxK
U2 - 10.1111/codi.16034
DO - 10.1111/codi.16034
M3 - Article
C2 - 35060263
AN - SCOPUS:85126925301
SN - 1462-8910
VL - 24
SP - 401
EP - 410
JO - Colorectal Disease
JF - Colorectal Disease
IS - 4
ER -
