Clin Colon Rectal Surg
DOI: 10.1055/s-0043-1770716
Review Article

Surveillance after Total Neoadjuvant Therapy: What to do for Near-Complete Responders

Garrett Friedman
1   Las Vegas Complex Surgical Specialists, Las Vegas, Nevada
› Author Affiliations
Funding None.

Abstract

A proportion of patients who undergo total neoadjuvant therapy for rectal cancer will achieve what is classified as a near-complete response. Significant debate exists as to the optimal management strategy for these patients with large heterogeneity in management. This article will examine the therapeutic and surveillance options for these patients as well as the relevant outcomes data.



Publication History

Article published online:
13 September 2023

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  • References

  • 1 Smith JJ, Chow OS, Gollub MJ. et al; Rectal Cancer Consortium. Organ Preservation in Rectal Adenocarcinoma: a phase II randomized controlled trial evaluating 3-year disease-free survival in patients with locally advanced rectal cancer treated with chemoradiation plus induction or consolidation chemotherapy, and total mesorectal excision or nonoperative management. BMC Cancer 2015; 15 (01) 767
  • 2 Garcia-Aguilar J, Patil S, Gollub MJ. et al. Organ preservation in patients with rectal adenocarcinoma treated with total neoadjuvant therapy. J Clin Oncol 2022; 40 (23) 2546-2556
  • 3 Maas M, Lambregts DM, Nelemans PJ. et al. Assessment of clinical complete response after chemoradiation for rectal cancer with digital rectal examination, endoscopy, and MRI: selection for organ-saving treatment. Ann Surg Oncol 2015; 22 (12) 3873-3880
  • 4 Garcia-Aguilar J, Chow OS, Smith DD. et al; Timing of Rectal Cancer Response to Chemoradiation Consortium. Effect of adding mFOLFOX6 after neoadjuvant chemoradiation in locally advanced rectal cancer: a multicentre, phase 2 trial. Lancet Oncol 2015; 16 (08) 957-966
  • 5 Probst CP, Becerra AZ, Aquina CT. et al; Consortium for Optimizing the Surgical Treatment of Rectal Cancer (OSTRiCh). Extended intervals after neoadjuvant therapy in locally advanced rectal cancer: the key to improved tumor response and potential organ preservation. J Am Coll Surg 2015; 221 (02) 430-440
  • 6 Marchegiani F, Palatucci V, Capelli G. et al. Rectal sparing approach after neoadjuvant therapy in patients with rectal cancer: the preliminary results of the ReSARCh trial. Ann Surg Oncol 2022; 29 (03) 1880-1889
  • 7 Fokas E, Allgäuer M, Polat B. et al; German Rectal Cancer Study Group. Randomized phase II trial of chemoradiotherapy plus induction or consolidation chemotherapy as total neoadjuvant therapy for locally advanced rectal cancer: CAO/ARO/AIO-12. J Clin Oncol 2019; 37 (34) 3212-3222
  • 8 Tie J, Wang Y, Tomasetti C. et al. Circulating tumor DNA analysis detects minimal residual disease and predicts recurrence in patients with stage II colon cancer. Sci Transl Med 2016; 8 (346) 346ra92
  • 9 Tie J, Cohen JD, Wang Y. et al. Serial circulating tumour DNA analysis during multimodality treatment of locally advanced rectal cancer: a prospective biomarker study. Gut 2019; 68 (04) 663-671
  • 10 McDuff SGR, Hardiman KM, Ulintz PJ. et al. Circulating tumor DNA predicts pathologic and clinical outcomes following neoadjuvant chemoradiation and surgery for patients with locally advanced rectal cancer. JCO Precis Oncol 2021; 5 (05) 123-132
  • 11 Fernandez LM, Figueiredo NL, Habr-Gama A. et al. Salvage surgery with organ preservation for patients with local regrowth after watch and wait: is it still possible?. Dis Colon Rectum 2020; 63 (08) 1053-1062
  • 12 Martens MH, Maas M, Heijnen LA. et al. Long-term outcome of an organ preservation program after neoadjuvant treatment for rectal cancer. J Natl Cancer Inst 2016; 108 (12) djw171
  • 13 Peltrini R, Imperatore N, Di Nuzzo MM, Pellino G. Towards personalized treatment of T2N0 rectal cancer: a systematic review of long-term oncological outcomes of neoadjuvant therapy followed by local excision. J Gastroenterol Hepatol 2022; 37 (08) 1426-1433