De gemiddelde oncoloog weet dit niet, lekker bezig he?


11 november 2011: Bron: ©American Society of Clinical Oncology

Wanneer bij patiënten met endeldarmkanker – rectumkanker een volledige remissie wordt bereikt door een combinatiebehandeling van chemo en bestraling – radiotherapie lijkt een operatie niet nodig and lijkt een wait-and-see beleid voldoende. Dit blijkt uit de resultaten van een Nederlandse studie uitgevoerd in Maastricht. Een kleinschalige gerandomiseerde studie bij totaal 41 patienten met niet uitgezaaide rectumkanker. Deze studie bevestigt een grotere studie, waarvan de resultaten werden gepresenteerd al weer in 2006. Zie onderaan dit artikel abstract van die studie.

Wait-and-See Policy for Clinical Complete Responders After Chemoradiation for Rectal Cancer

  1. Monique Maas,
  2. Regina G.H. Beets-Tan,
  3. Doenja M.J. Lambregts,
  4. Guido Lammering,
  5. Patty J. Nelemans,
  6. Sanne M.E. Engelen,
  7. Ronald M. van Dam,
  8. Rob L.H. Jansen,
  9. Meindert Sosef,
  10. Jeroen W.A. Leijtens,
  11. Karel W.E. Hulsewé,
  12. Jeroen Buijsen and
  13. Geerard L. Beets

+ Author Affiliations


  1. Monique Maas, Regina G.H. Beets-Tan, Doenja M.J. Lambregts, Sanne M.E. Engelen, Ronald M. van Dam, Rob L.H. Jansen, and Geerard L. Beets, Maastricht University Medical Center; Patty J. Nelemans, Maastricht University; Guido Lammering and Jeroen Buijsen, Maastro Clinic, Maastricht; Meindert Sosef, Atrium Medical Center, Heerlen; Jeroen W.A. Leijtens, Laurentius Hospital, Roermond; and Karel W.E. Hulsewé, Orbis Medical Center, Sittard, the Netherlands.
  1. Corresponding author: Geerard L. Beets, MD, PhD, Maastricht University Medical Center, PO Box 5800, Maastricht, the Netherlands 6202 AZ; e-mail: g.beets@mumc.nl.

Abstract

Purpose Neoadjuvant chemoradiotherapy for rectal cancer can result in complete disappearance of tumor and involved nodes. In patients without residual tumor on imaging and endoscopy (clinical complete response ) a wait-and-see-policy (omission of surgery with follow-up) might be considered instead of surgery. The purpose of this prospective cohort study was to evaluate feasibility and safety of a wait-and-see policy with strict selection criteria and follow-up.

Patients and Methods Patients with a cCR after chemoradiotherapy were prospectively selected for the wait-and-see policy with magnetic resonance imaging (MRI) and endoscopy plus biopsies. Follow-up was performed 3 to 6 monthly and consisted of MRI, endoscopy, and computed tomography scans. A control group of patients with a pathologic complete response (pCR) after surgery was identified from a prospective cohort study. Functional outcome was measured with the Memorial Sloan-Kettering Cancer Center (MSKCC) bowel function questionnaire and Wexner incontinence score. Long-term outcome was estimated by using Kaplan-Meier curves.

Results Twenty-one patients with cCR were included in the wait-and-see policy group. Mean follow-up was 25 ± 19 months. One patient developed a local recurrence and had surgery as salvage treatment. The other 20 patients are alive without disease. The control group consisted of 20 patients with a pCR after surgery who had a mean follow-up of 35 ± 23 months. For these patients with a pCR, cumulative probabilities of 2-year disease-free survival and overall survival were 93% and 91%, respectively.

Conclusion A wait-and-see policy with strict selection criteria, up-to-date imaging techniques, and follow-up is feasible and results in promising outcome at least as good as that of patients with a pCR after surgery. The proposed selection criteria and follow-up could form the basis for future randomized studies.

Footnotes

  • Received June 20, 2011.
  • Accepted July 25, 2011

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