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Custers, Petra A; Geubels, Barbara M; Beets, Geerard L; Lambregts, Doenja M J; van Leerdam, Monique E; van Triest, Baukelien; Maas, Monique

Defining near-complete response following (chemo)radiotherapy for rectal cancer: systematic review

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  • Medientyp: E-Artikel
  • Titel: Defining near-complete response following (chemo)radiotherapy for rectal cancer: systematic review
  • Beteiligte: Custers, Petra A; Geubels, Barbara M; Beets, Geerard L; Lambregts, Doenja M J; van Leerdam, Monique E; van Triest, Baukelien; Maas, Monique
  • Erschienen: Oxford University Press (OUP), 2022
  • Erschienen in: British Journal of Surgery
  • Sprache: Englisch
  • DOI: 10.1093/bjs/znac372
  • ISSN: 0007-1323; 1365-2168
  • Entstehung:
  • Anmerkungen:
  • Beschreibung: <jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>A uniform definition of a clinical near-complete response (near-CR) after neoadjuvant (chemo)radiotherapy for rectal cancer is lacking. A clear definition is necessary for uniformity in clinical practice and trial enrolment for organ-preserving treatments. This review aimed to provide an overview of the terminology, criteria, and features used in the literature to define a near-CR.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A systematic review was performed based on the PRISMA statement. PubMed and Embase were searched up to May 2021 to identify the terminology, criteria, and features used to define a near-CR after (chemo)radiotherapy for rectal cancer. Studies with no clear cut-off point between a cCR and near-CR, studies using Response Evaluation Criteria In Solid Tumours, and studies including only complete responders were excluded.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>A total of 1876 articles were found, of which 23 were included. Patients were managed by watchful waiting and/or additional local treatment in 11 and 17 of 23 studies respectively. Response evaluation included digital rectal examination (DRE) and/or endoscopy with MRI in 18 studies. The majority of studies used the term ‘near-complete response’. In most studies, minor irregularities or a smooth induration with DRE and a small flat ulcer on endoscopy were considered to indicate a near-CR. On MRI, five studies used features (obvious downstaging with or without heterogeneous/irregular fibrosis on T2-weighted MRI or small spot of high signal on diffusion-weighted imaging), five studies used TNM criteria (ycT2), and four used magnetic resonance tumour regression grade (mrTRG) (mrTRG1–2/mrTRG2) to describe a near-CR.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>The terminology, criteria, and features used to describe a near-CR vary substantially, which can partly be explained by the different treatment strategies patients are selected for (watchful waiting or additional local treatment). A reproducible definition of near-CR is required.</jats:p> </jats:sec>