Wait-and-see treatment strategies for rectal cancer patients with clinical complete response after neoadjuvant chemoradiotherapy: a systematic review and meta-analysis
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Jun Li1, Lunjin Li2, Lin Yang3, Jiatian Yuan1, Bo Lv1, Yanan Yao4 and Shasha Xing5
1 General Surgery Department and Central Laboratory, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, People’s Republic of China
2 Pharmacy Department, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, People’s Republic of China
3 Department of Pathology, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
4 Department of General Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
5 Central Laboratory, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, People’s Republic of China
Jun Li, email:
Lunjin Li, email:
Lin Yang, email:
Keywords: rectal cancer, clinical complete response, neoadjuvant chemoradiotherapy, wait-and-see
Received: December 14, 2015 Accepted: March 28, 2016 Published: April 06, 2016
Wait-and-see treatment strategies may benefit rectal cancer patients who achieve a clinical complete response (cCR) after neoadjuvant chemoradiotherapy (NCRT). In this study, we analyzed data from 9 eligible trials to compare the oncologic outcomes of 251 rectal cancer patients achieving a cCR through nonsurgical management approaches with the outcomes of 344 patients achieving a pathologic complete response (pCR) through radical surgery. The two patient groups did not differ in distant metastasis rates or disease-free and overall survival, but the nonsurgical group had a higher risk of 1, 2, 3, and 5-year local recurrence. Hence, we concluded that for rectal cancer patients achieving a cCR after NCRT, a wait-and-see strategy with strict selection criteria, an appropriate follow-up schedule, and salvage treatments achieved outcomes at least as good as radical surgery. Long-term randomized and controlled trials with more uniform inclusion criteria and standardized follow-up schedules will help clarify the risks and benefits of wait-and-see treatment strategies for these patients.
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