AI Article Synopsis

  • The study aimed to identify predictive factors for clinical complete response (cCR) in patients undergoing a watch-and-wait strategy after preoperative radiotherapy.
  • A total of 490 patients were analyzed; 73 achieved cCR, with varying rates based on cancer risk levels: 39.0% for low-risk, 16.8% for intermediate-risk, and only 5.4% for high-risk cancers.
  • Significant predictors for achieving cCR included tumor volume and nodal status, raising concerns about the viability of the watch-and-wait approach for patients with larger or circular tumors.

Article Abstract

Background: Frequency and predictive factors for a clinical complete response (cCR) in unselected patients are unclear.

Material And Methods: Two prospective observational studies were designed and pooled to explore predictive factors for cCR. Both studies evaluated the watch-and-wait strategy in consecutive patients; the first single-institutional study in elderly with a small tumour, the second multi-institutional study in all the patients receiving standard of care preoperative radiotherapy.

Results: Four hundred and ninety patients were analysed. Short-course radiotherapy alone, or with consolidation chemotherapy or chemoradiation was given to 40.6%, 40.2% and 19.2% of the patients, respectively. The median interval from the radiation start to the first tumour response assessment was 10.2 weeks for short-course radiation and 13.2 weeks for chemoradiation. Seventy-three patients had cCR and 71 underwent w&w with the median follow-up of 24 months. The regrowth rate was 26.8%. cCR rate was 39.0% for low-risk cancer (cT1-2N0), 16.8% for intermediate-risk (cT3 with unthreatened mesorectal fascia [MRF-] or cT2N+) and 5.4% for high-risk (cT4 or MRF+). In the multivariable analysis, tumour volume (or tumour length and circumferential extent) and cN status were significant predictors for cCR. In circular cancers or with a length ≥7 cm (n = 184), cCR rate was only 2.7%, sustained cCR 1.6% and the sensitivity of cCR diagnosis 23.1%. None of 27 patients with a tumour larger than 120 cm achieved cCR.

Conclusions: Considering watch-and-wait strategy is questionable in patients with circular tumours or with tumour length ≥7 cm.

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Source
http://dx.doi.org/10.1016/j.radonc.2021.05.014DOI Listing

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