In:
Diseases of the Colon & Rectum, Ovid Technologies (Wolters Kluwer Health)
Abstract:
A proportion of patients that achieve a clinical complete response may develop local regrowth. While salvage appears to provide appropriate local control, the risk of distant metastases is less known. OBJECTIVE: Compare the risk of distant metastases between patients that achieve a complete clinical response (watch-and-wait strategy) and subsequent local regrowth to patients managed by surgery after chemoradiation. DESIGN: Retrospective multicenter cohort study. SETTINGS: This study used data of patients from 3 institutions that were treated between 1993 and 2019. PATIENTS: Patients with initial clinical complete response (after neoadjuvant therapy) followed by local regrowth and patients with near-complete pathological response (≤10%) after straightforward surgery after chemoradiation. MAIN OUTCOME MEASURES: Univariate/multivariate analysis was performed to identify risk factors for distant metastases. Kaplan-Meier curves were created (log-rank test) to compare survival outcomes. Analysis were performed using time-zero as last day of radiation therapy (1) or as date of salvage resection (2) in the local regrowth group. RESULTS: Twenty-one of 79 patients with local regrowth developed distant metastases while only 10 out of 74 after straightforward surgery ( p = 0.04). Local regrowth and final pathology (ypT3-4) were the only independent risk factors associated with distant metastases. When using date of salvage resection as time-zero, distant-metastases-free survival rates was significantly inferior for patients with local regrowth (70 vs. 86%; p = 0.01). LIMITATIONS: Small number of patients, many neoadjuvant therapies, selection bias. CONCLUSIONS: Patients undergoing watch-and-wait who develop local regrowth are at higher risk for development of distant metastases compared to patients with near-complete pathological response managed by surgery upfront after chemoradiation.
Type of Medium:
Online Resource
ISSN:
0012-3706
DOI:
10.1097/DCR.0000000000002930
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2023
detail.hit.zdb_id:
2046914-7
