Quality of Life in Patients With Rectal Cancer After Chemoradiation: Watch-and-Wait Policy Versus Standard Resection–Are We Comparing Apples to Oranges?

Quality of Life in Patients With Rectal Cancer After Chemoradiation: Watch-and-Wait Policy Versus... DISEASES OF THE COLON & RECTUM VOLUME 61: 3 (2018) e21 Audrey S. Kulaylat, M.D. ≤cN1, ≤cT3a/b) after upfront TME alone. At the same David B. Stewart, M.D. time, being more likely to develop cCR after nCRT and Department of Surgery Penn State Hershey avoid definitive surgery, they would have been excluded Medical Center from the possibility of organ preservation by undergoing 8,9 Hershey, Pennsylvania straight to upfront TME alone. REFERENCES Quality of Life in Patients 1. Hupkens BJP, Martens MH, Stoot JH, et al. Quality of life in With Rectal Cancer After rectal cancer patients after chemoradiation: watch-and-wait policy versus standard resection–a matched-controlled study. Chemoradiation: Watch-and- Dis Colon Rectum. 2017;60:1032–1040. 2. Habr-Gama A, Perez RO, Wynn G, Marks J, Kessler H, Gama- Wait Policy Versus Standard Rodrigues J. Complete clinical response after neoadjuvant chemoradiation therapy for distal rectal cancer: characterization Resection–Are We Comparing of clinical and endoscopic findings for standardization. Dis Apples to Oranges? Colon Rectum. 2010;53:1692–1698. 3. Habr-Gama A, Perez RO, Nadalin W, et al. Operative versus To the Editor–Quality of life after organ preservation nonoperative treatment for stage 0 distal rectal cancer (watch and wait) for patients with rectal cancer is a very following chemoradiation therapy: long-term results. Ann relevant issue. However, the comparison of patients who Surg. 2004;240:711–717. develop complete clinical response (cCR) who undergo 4. Maas M, Beets-Tan RG, Lambregts DM, et al. Wait-and-see policy for clinical complete responders after chemoradiation watch and wait versus those who undergo total mesorectal for rectal cancer. J Clin Oncol. 2011;29:4633–4640. excision (TME) may ultimately be comparing apples to 5. Dossa F, Chesney TR, Acuna SA, Baxter NN. A watch- and- oranges. wait approach for locally advanced rectal cancer after a clinical Comparing the outcomes of these 2 modalities only complete response following neoadjuvant chemoradiation: make sense when both alternatives would be possible for a systematic review and meta-analysis. Lancet Gastroenterol all patients. In the absence of information on response Hepatol. 2017;2:501–513. to neoadjuvant chemoradiotherapy (nCRT) in the 6. Habr-Gama A, Gama-Rodrigues J, Perez RO. Is tailoring TME group, it is not clear whether these patients would treatment of rectal cancer the only true benefit of long- have ever been candidates for organ preservation. If course neoadjuvant chemoradiation? Dis Colon Rectum. TME patients constitute a subgroup of patients with 2013;56:264–266. incomplete response, demonstration of any differences 7. Habr-Gama A, Sao Juliao GP, Vailati BB, et al. Organ in quality of life may have little clinical significance and preservation in cT2N0 rectal cancer after neoadjuvant is ultimately driven by response to nCRT instead of the chemoradiation therapy: the impact of radiation therapy dose- actual strategy used. escalation and consolidation chemotherapy. Ann Surg. In press. 8. Sao Juliao GP, Habr-Gama A, Vailati BB, Perez RO. The good, The solution to this puzzle would be the comparison the bad and the ugly: rectal cancers in the twenty-first century. of patients with cCR managed by organ preservation Tech Coloproctol. 2017;21:573–575. exclusively with patients with complete pathological 3–5 9. Habr-Gama A, São Julião GP, Gama-Rodrigues J, et al. Baseline T response after TME. However, a far more interesting classification predicts early tumor regrowth after nonoperative and clinically relevant question regards the comparison management in distal rectal cancer after extended neoadjuvant of quality of life among all of the patients undergoing chemoradiation and initial complete clinical response. Dis nCRT in an attempt to achieve cCR and avoid TME versus Colon Rectum. 2017;60:586–594. 6,7 upfront TME surgery without nCRT. This would provide a more meaningful piece of information in deciding the 1 Bruna Borba Vailati, M.D. best treatment strategy for a distal rectal cancer considered 1,2 Angelita Habr-Gama, M.D., Ph.D. to be low risk (safe circumferential resection margin, Adrian E. Mattacheo, M.D. Guilherme Pagin São Julião, M.D. 1,3,4 Rodrigo Oliva Perez, M.D., Ph.D. Funding/Support: None reported. Angelita & Joaquim Gama Institute University of São Paulo School of Medicine Financial Disclosure: None reported. University of São Paulo School of Medicine Colorectal Surgery Division Dis Colon Rectum 2018; 61: e21 Ludwig Institute for Cancer Research São Paulo Branch DOI: 10.1097/DCR.0000000000001018 São Paulo, Brazil © The ASCRS 2018 Copyright © The American Society of Colon & Rectal Surgeons, Inc. Unauthorized reproduction of this article is prohibited. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Diseases of the Colon & Rectum Wolters Kluwer Health

Quality of Life in Patients With Rectal Cancer After Chemoradiation: Watch-and-Wait Policy Versus Standard Resection–Are We Comparing Apples to Oranges?

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Wolters Kluwer
Copyright
© The ASCRS 2018
ISSN
0012-3706
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1530-0358
D.O.I.
10.1097/DCR.0000000000001018
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Abstract

DISEASES OF THE COLON & RECTUM VOLUME 61: 3 (2018) e21 Audrey S. Kulaylat, M.D. ≤cN1, ≤cT3a/b) after upfront TME alone. At the same David B. Stewart, M.D. time, being more likely to develop cCR after nCRT and Department of Surgery Penn State Hershey avoid definitive surgery, they would have been excluded Medical Center from the possibility of organ preservation by undergoing 8,9 Hershey, Pennsylvania straight to upfront TME alone. REFERENCES Quality of Life in Patients 1. Hupkens BJP, Martens MH, Stoot JH, et al. Quality of life in With Rectal Cancer After rectal cancer patients after chemoradiation: watch-and-wait policy versus standard resection–a matched-controlled study. Chemoradiation: Watch-and- Dis Colon Rectum. 2017;60:1032–1040. 2. Habr-Gama A, Perez RO, Wynn G, Marks J, Kessler H, Gama- Wait Policy Versus Standard Rodrigues J. Complete clinical response after neoadjuvant chemoradiation therapy for distal rectal cancer: characterization Resection–Are We Comparing of clinical and endoscopic findings for standardization. Dis Apples to Oranges? Colon Rectum. 2010;53:1692–1698. 3. Habr-Gama A, Perez RO, Nadalin W, et al. Operative versus To the Editor–Quality of life after organ preservation nonoperative treatment for stage 0 distal rectal cancer (watch and wait) for patients with rectal cancer is a very following chemoradiation therapy: long-term results. Ann relevant issue. However, the comparison of patients who Surg. 2004;240:711–717. develop complete clinical response (cCR) who undergo 4. Maas M, Beets-Tan RG, Lambregts DM, et al. Wait-and-see policy for clinical complete responders after chemoradiation watch and wait versus those who undergo total mesorectal for rectal cancer. J Clin Oncol. 2011;29:4633–4640. excision (TME) may ultimately be comparing apples to 5. Dossa F, Chesney TR, Acuna SA, Baxter NN. A watch- and- oranges. wait approach for locally advanced rectal cancer after a clinical Comparing the outcomes of these 2 modalities only complete response following neoadjuvant chemoradiation: make sense when both alternatives would be possible for a systematic review and meta-analysis. Lancet Gastroenterol all patients. In the absence of information on response Hepatol. 2017;2:501–513. to neoadjuvant chemoradiotherapy (nCRT) in the 6. Habr-Gama A, Gama-Rodrigues J, Perez RO. Is tailoring TME group, it is not clear whether these patients would treatment of rectal cancer the only true benefit of long- have ever been candidates for organ preservation. If course neoadjuvant chemoradiation? Dis Colon Rectum. TME patients constitute a subgroup of patients with 2013;56:264–266. incomplete response, demonstration of any differences 7. Habr-Gama A, Sao Juliao GP, Vailati BB, et al. Organ in quality of life may have little clinical significance and preservation in cT2N0 rectal cancer after neoadjuvant is ultimately driven by response to nCRT instead of the chemoradiation therapy: the impact of radiation therapy dose- actual strategy used. escalation and consolidation chemotherapy. Ann Surg. In press. 8. Sao Juliao GP, Habr-Gama A, Vailati BB, Perez RO. The good, The solution to this puzzle would be the comparison the bad and the ugly: rectal cancers in the twenty-first century. of patients with cCR managed by organ preservation Tech Coloproctol. 2017;21:573–575. exclusively with patients with complete pathological 3–5 9. Habr-Gama A, São Julião GP, Gama-Rodrigues J, et al. Baseline T response after TME. However, a far more interesting classification predicts early tumor regrowth after nonoperative and clinically relevant question regards the comparison management in distal rectal cancer after extended neoadjuvant of quality of life among all of the patients undergoing chemoradiation and initial complete clinical response. Dis nCRT in an attempt to achieve cCR and avoid TME versus Colon Rectum. 2017;60:586–594. 6,7 upfront TME surgery without nCRT. This would provide a more meaningful piece of information in deciding the 1 Bruna Borba Vailati, M.D. best treatment strategy for a distal rectal cancer considered 1,2 Angelita Habr-Gama, M.D., Ph.D. to be low risk (safe circumferential resection margin, Adrian E. Mattacheo, M.D. Guilherme Pagin São Julião, M.D. 1,3,4 Rodrigo Oliva Perez, M.D., Ph.D. Funding/Support: None reported. Angelita & Joaquim Gama Institute University of São Paulo School of Medicine Financial Disclosure: None reported. University of São Paulo School of Medicine Colorectal Surgery Division Dis Colon Rectum 2018; 61: e21 Ludwig Institute for Cancer Research São Paulo Branch DOI: 10.1097/DCR.0000000000001018 São Paulo, Brazil © The ASCRS 2018 Copyright © The American Society of Colon & Rectal Surgeons, Inc. Unauthorized reproduction of this article is prohibited.

Journal

Diseases of the Colon & RectumWolters Kluwer Health

Published: Mar 1, 2018

References

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