Skip to main content

Maximizing Neoadjuvant Treatment Response and Watch and Wait

  • Chapter
  • First Online:

Abstract

Neoadjuvant therapy has been a keystone supporting the advances we have made in the treatment of rectal cancer. The reason for maximizing tumor response to neoadjuvant treatment is clear: as response improves, the consideration of less invasive treatment options such as local excision and “watch-and-wait” (nonoperative) strategies can be explored. Tumor response is closely correlated with long-term oncologic outcome, and the optimization of tumor response to neoadjuvant therapy is thought to improve long-term outcomes as well [1–3]. Maximizing neoadjuvant treatment response is therefore expected to have profound effects on both oncologic outcomes and quality of life.

This is a preview of subscription content, log in via an institution.

References

  1. De Campos-Lobato LF, Stocchi L, da Luz MA, et al. Pathologic complete response after neoadjuvant treatment for rectal cancer decreases distant recurrence and could eradicate local recurrence. Ann Surg Oncol. 2011;18:1590–8.

    Article  PubMed  Google Scholar 

  2. Maas M, Nelemans PJ, Valentini V, et al. Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data. Lancet Oncol. 2010;11:835–44.

    Article  PubMed  Google Scholar 

  3. Martin ST, Heneghan HM, Winter DC. Systematic review and meta-analysis of outcomes following pathological complete response to neoadjuvant chemoradiotherapy for rectal cancer. Br J Surg. 2012;99:918–28.

    Article  CAS  PubMed  Google Scholar 

  4. Binkley GE. Gold radon seeds in rectal cancer. Ann Surg. 1935;102:72–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Stearns MW, Deddish MR, Quan SH. Preoperative roentgen therapy for cancer of the rectum. Surg Gynecol Obstet. 1959;109:225–9.

    PubMed  Google Scholar 

  6. Cammà C, Giunta M, Fiorica F, et al. Preoperative radiotherapy for resectable rectal cancer: a meta-analysis. JAMA. 2000;284:1008–15.

    Article  PubMed  Google Scholar 

  7. Colorectal Cancer. Adjuvant radiotherapy for rectal cancer: a systematic overview of 8,507 patients from 22 randomised trials. Lancet. 2001;358:1291–304.

    Article  Google Scholar 

  8. Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet. 1986;1:1479–82.

    Article  CAS  PubMed  Google Scholar 

  9. Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001;345:638–46.

    Article  CAS  PubMed  Google Scholar 

  10. Gérard J-P, Conroy T, Bonnetain F, et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol. 2006;24:4620–5.

    Article  PubMed  Google Scholar 

  11. Bosset J-F, Collette L, Calais G, et al. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med. 2006;355:1114–23.

    Article  CAS  PubMed  Google Scholar 

  12. Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351:1731–40.

    Article  CAS  PubMed  Google Scholar 

  13. MacFarlane JK, Ryall RD, Heald RJ. Mesorectal excision for rectal cancer. Lancet. 1993;341:457–60.

    Article  CAS  PubMed  Google Scholar 

  14. Cedermark B, Johansson H, Rutqvist LE, et al. The Stockholm I trial of preoperative short term radiotherapy in operable rectal carcinoma. A prospective randomized trial. Stockholm Colorectal Cancer Study Group. Cancer. 1995;75:2269–75.

    Article  CAS  PubMed  Google Scholar 

  15. Martling A, Holm T, Johansson H, et al. The Stockholm II trial on preoperative radiotherapy in rectal carcinoma: long-term follow-up of a population-based study. Cancer. 2001;92:896–902.

    Article  CAS  PubMed  Google Scholar 

  16. Braendengen M, Tveit KM, Berglund A, et al. Randomized phase III study comparing preoperative radiotherapy with chemoradiotherapy in nonresectable rectal cancer. J Clin Oncol. 2008;26:3687–94.

    Article  CAS  PubMed  Google Scholar 

  17. Swedish Rectal Cancer Trial. Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med. 1997;336:980–7.

    Article  Google Scholar 

  18. Birgisson H, Påhlman L, Gunnarsson U, et al. Adverse effects of preoperative radiation therapy for rectal cancer: long-term follow-up of the Swedish Rectal Cancer Trial. J Clin Oncol. 2005;23:8697–705.

    Article  PubMed  Google Scholar 

  19. Peeters KCMJ, Marijnen CAM, Nagtegaal ID, et al. The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg. 2007;246:693–701.

    Article  PubMed  Google Scholar 

  20. Van Gijn W, Marijnen CAM, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol. 2011;12:575–82.

    Article  PubMed  Google Scholar 

  21. Sauer R, Liersch T, Merkel S, et al. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol. 2012;30:1926–33.

    Article  CAS  PubMed  Google Scholar 

  22. Byfield JE. 5-fluorouracil radiation sensitization—a brief review. Investig New Drugs. 1989;7:111–6.

    Article  CAS  Google Scholar 

  23. Krook JE, Moertel CG, Gunderson LL, et al. Effective surgical adjuvant therapy for high-risk rectal carcinoma. N Engl J Med. 1991;324:709–15.

    Article  CAS  PubMed  Google Scholar 

  24. Gastrointestinal Tumor Study Group. Prolongation of the disease-free interval in surgically treated rectal carcinoma. N Engl J Med. 1985;312:1465–72.

    Article  Google Scholar 

  25. O’Connell MJ, Martenson JA, Wieand HS, et al. Improving adjuvant therapy for rectal cancer by combining protracted-infusion fluorouracil with radiation therapy after curative surgery. N Engl J Med. 1994;331:502–7.

    Article  PubMed  Google Scholar 

  26. Smalley SR, Benedetti JK, Williamson SK, et al. Phase III trial of fluorouracil-based chemotherapy regimens plus radiotherapy in postoperative adjuvant rectal cancer: GI INT 0144. J Clin Oncol. 2006;24:3542–7.

    Article  CAS  PubMed  Google Scholar 

  27. Bosset J-F, Calais G, Mineur L, et al. Enhanced tumorocidal effect of chemotherapy with preoperative radiotherapy for rectal cancer: preliminary results–EORTC 22921. J Clin Oncol. 2005;23:5620–7.

    Article  CAS  PubMed  Google Scholar 

  28. Hofheinz R-D, Wenz F, Post S, et al. Chemoradiotherapy with capecitabine versus fluorouracil for locally advanced rectal cancer: a randomised, multicentre, non-inferiority, phase 3 trial. Lancet Oncol. 2012;13:579–88.

    Article  CAS  PubMed  Google Scholar 

  29. O’Connell MJ, Colangelo LH, Beart RW, et al. Capecitabine and oxaliplatin in the preoperative multimodality treatment of rectal cancer: surgical end points from National Surgical Adjuvant Breast and Bowel Project trial R-04. J Clin Oncol. 2014;32:1927–34.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Aschele C, Cionini L, Lonardi S, et al. Primary tumor response to preoperative chemoradiation with or without oxaliplatin in locally advanced rectal cancer: pathologic results of the STAR-01 randomized phase III trial. J Clin Oncol. 2011;29:2773–80.

    Article  CAS  PubMed  Google Scholar 

  31. Gérard J-P, Azria D, Gourgou-Bourgade S, et al. Comparison of two neoadjuvant chemoradiotherapy regimens for locally advanced rectal cancer: results of the phase III trial ACCORD 12/0405-Prodige 2. J Clin Oncol. 2010;28:1638–44.

    Article  PubMed  Google Scholar 

  32. Rödel C, Liersch T, Becker H, et al. Preoperative chemoradiotherapy and postoperative chemotherapy with fluorouracil and oxaliplatin versus fluorouracil alone in locally advanced rectal cancer: initial results of the German CAO/ARO/AIO-04 randomised phase 3 trial. Lancet Oncol. 2012;13:679–87.

    Article  PubMed  Google Scholar 

  33. Jin T, Zhu Y, Luo J-L, et al. Prospective phase II trial of nimotuzumab in combination with radiotherapy and concurrent capecitabine in locally advanced rectal cancer. Int J Color Dis. 2015;30:337–45.

    Article  Google Scholar 

  34. Eisterer W, De Vries A, Öfner D, et al. Preoperative treatment with capecitabine, cetuximab and radiotherapy for primary locally advanced rectal cancer—a phase II clinical trial. Anticancer Res. 2014;34:6767–73.

    CAS  PubMed  Google Scholar 

  35. Kim SY, Shim EK, Yeo HY, et al. KRAS mutation status and clinical outcome of preoperative chemoradiation with cetuximab in locally advanced rectal cancer: a pooled analysis of 2 phase II trials. Int J Radiat Oncol. 2013;85:201–7.

    Article  CAS  Google Scholar 

  36. Dewdney A, Cunningham D, Tabernero J, et al. Multicenter randomized phase II clinical trial comparing neoadjuvant oxaliplatin, capecitabine, and preoperative radiotherapy with or without cetuximab followed by total mesorectal excision in patients with high-risk rectal cancer (EXPERT-C). J Clin Oncol. 2012;30:1620–7.

    Article  CAS  PubMed  Google Scholar 

  37. Glynne-Jones R, Mawdsley S, Harrison M. Antiepidermal growth factor receptor radiosensitizers in rectal cancer. Anti-Cancer Drugs. 2011;22:330–40.

    Article  CAS  PubMed  Google Scholar 

  38. Kim SY, Hong YS, Kim DY, et al. Preoperative chemoradiation with cetuximab, irinotecan, and capecitabine in patients with locally advanced resectable rectal cancer: a multicenter phase II study. Int J Radiat Oncol Biol Phys. 2011;81:677–83.

    Article  CAS  PubMed  Google Scholar 

  39. Wahba HA, El-Hadaad HA, Roshdy S. Combination of irinotecan and 5-fluorouracil with radiation in locally advanced rectal adenocarcinoma. J Gastrointest Cancer. 2012;43:467–71.

    Article  CAS  PubMed  Google Scholar 

  40. Urick ME, Chung EJ, Shield WP, et al. Enhancement of 5-fluorouracil-induced in vitro and in vivo radiosensitization with MEK inhibition. Clin Cancer Res. 2011;17:5038–47.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Kleiman LB, Krebs AM, Kim SY, et al. Comparative analysis of radiosensitizers for K-RAS mutant rectal cancers. PLoS One. 2013;8:e82982.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Deorukhkar A, Ahuja N, Mercado A-L, et al. Zerumbone increases oxidative stress in a thiol-dependent ROS-independent manner to increase DNA damage and sensitize colorectal cancer cells to radiation. Cancer Med. 2014;4:278–92.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Peeters KCMJ, van de Velde CJH, Leer JWH, et al. Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients—a Dutch Colorectal Cancer Group Study. J Clin Oncol. 2005;23:6199–206.

    Article  CAS  PubMed  Google Scholar 

  44. Bujko K, Nowacki MP, Nasierowska-Guttmejer A, et al. Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg. 2006;93:1215–23.

    Article  CAS  PubMed  Google Scholar 

  45. Ngan SY, Burmeister B, Fisher RJ, et al. Randomized trial of short-course radiotherapy versus long-course chemoradiation comparing rates of local recurrence in patients with T3 rectal cancer: Trans-Tasman Radiation Oncology Group trial 01.04. J Clin Oncol. 2012;30:3827–33.

    Article  PubMed  Google Scholar 

  46. Tan D, Glynne-Jones R. But some neoadjuvant schedules are more equal than others. J Clin Oncol. 2013;31:1799–800.

    Article  CAS  PubMed  Google Scholar 

  47. Bujko K. Short-course preoperative radiotherapy for low rectal cancer. J Clin Oncol. 2013;31:1799.

    Article  PubMed  Google Scholar 

  48. Ruff CC, Dockerty MB, Fricke RE, et al. Preoperative radiation therapy for adenocarcinoma of the rectum and rectosigmoid. Surg Gynecol Obstet. 1961;112:715–23.

    CAS  PubMed  Google Scholar 

  49. Brierley JD, Cummings BJ, Wong CS, et al. Adenocarcinoma of the rectum treated by radical external radiation therapy. Int J Radiat Oncol Biol Phys. 1995;31:255–9.

    Article  CAS  PubMed  Google Scholar 

  50. Supiot S, Bennouna J, Rio E, et al. Negative influence of delayed surgery on survival after preoperative radiotherapy in rectal cancer. Color Dis. 2006;8:430–5.

    Article  CAS  Google Scholar 

  51. Kalady MF, de Campos-Lobato LF, Stocchi L, et al. Predictive factors of pathologic complete response after neoadjuvant chemoradiation for rectal cancer. Ann Surg. 2009;250:582–9.

    PubMed  Google Scholar 

  52. Wolthuis AM, Penninckx F, Haustermans K, et al. Impact of interval between neoadjuvant chemoradiotherapy and TME for locally advanced rectal cancer on pathologic response and oncologic outcome. Ann Surg Oncol. 2012;19:2833–41.

    Article  PubMed  Google Scholar 

  53. Zeng W-G, Zhou Z-X, Liang J-W, et al. Impact of interval between neoadjuvant chemoradiotherapy and surgery for rectal cancer on surgical and oncologic outcome. J Surg Oncol. 2014;110:463–7.

    Article  PubMed  Google Scholar 

  54. Calvo FA, Morillo V, Santos M, et al. Interval between neoadjuvant treatment and definitive surgery in locally advanced rectal cancer: impact on response and oncologic outcomes. J Cancer Res Clin Oncol. 2014;140:1651–60.

    Article  CAS  PubMed  Google Scholar 

  55. Francois Y, Nemoz CJ, Baulieux J, et al. Influence of the interval between preoperative radiation therapy and surgery on downstaging and on the rate of sphincter-sparing surgery for rectal cancer: the Lyon R90-01 randomized trial. J Clin Oncol. 1999;17:2396.

    Article  CAS  PubMed  Google Scholar 

  56. Habr-Gama A, Perez RO, Proscurshim I, et al. Interval between surgery and neoadjuvant chemoradiation therapy for distal rectal cancer: does delayed surgery have an impact on outcome? Int J Radiat Oncol Biol Phys. 2008;71:1181–8.

    Article  PubMed  Google Scholar 

  57. Garcia-Aguilar J, Smith DD, Avila K, et al. Optimal timing of surgery after chemoradiation for advanced rectal cancer: preliminary results of a multicenter, nonrandomized phase II prospective trial. Ann Surg. 2011;254:97–102.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Glynne-Jones R, Grainger J, Harrison M, et al. Neoadjuvant chemotherapy prior to preoperative chemoradiation or radiation in rectal cancer: should we be more cautious? Br J Cancer. 2006;94:363–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Hayden DM, Pinzon MCM, Francescatti AB, et al. Hospital readmission for fluid and electrolyte abnormalities following ileostomy construction: preventable or unpredictable? J Gastrointest Surg. 2013;17:298–303.

    Article  PubMed  Google Scholar 

  60. Khrizman P, Niland JC, ter Veer A, et al. Postoperative adjuvant chemotherapy use in patients with stage II/III rectal cancer treated with neoadjuvant therapy: a national comprehensive cancer network analysis. J Clin Oncol. 2013;31:30–8.

    Article  PubMed  Google Scholar 

  61. Biagi JJ, Raphael MJ, Mackillop WJ, et al. Association between time to initiation of adjuvant chemotherapy and survival in colorectal cancer: a systematic review and meta-analysis. JAMA. 2011;305:2335–42.

    Article  CAS  PubMed  Google Scholar 

  62. Breugom AJ, Swets M, Bosset J-F, et al. Adjuvant chemotherapy after preoperative (chemo)radiotherapy and surgery for patients with rectal cancer: a systematic review and meta-analysis of individual patient data. Lancet Oncol. 2015;16:200–7.

    Article  CAS  PubMed  Google Scholar 

  63. Calvo FA, Serrano FJ, Diaz-González JA, et al. Improved incidence of pT0 downstaged surgical specimens in locally advanced rectal cancer (LARC) treated with induction oxaliplatin plus 5-fluorouracil and preoperative chemoradiation. Ann Oncol. 2006;17:1103–10.

    Article  CAS  PubMed  Google Scholar 

  64. Schou JV, Larsen FO, Rasch L, et al. Induction chemotherapy with capecitabine and oxaliplatin followed by chemoradiotherapy before total mesorectal excision in patients with locally advanced rectal cancer. Ann Oncol. 2012;23:2627–33.

    Article  CAS  PubMed  Google Scholar 

  65. Chua YJ, Barbachano Y, Cunningham D, et al. Neoadjuvant capecitabine and oxaliplatin before chemoradiotherapy and total mesorectal excision in MRI-defined poor-risk rectal cancer: a phase 2 trial. Lancet Oncol. 2010;11:241–8.

    Article  CAS  PubMed  Google Scholar 

  66. Maréchal R, Vos B, Polus M, et al. Short course chemotherapy followed by concomitant chemoradiotherapy and surgery in locally advanced rectal cancer: a randomized multicentric phase II study. Ann Oncol. 2012;23:1525–30.

    Article  PubMed  Google Scholar 

  67. Cercek A, Goodman KA, Hajj C, et al. Neoadjuvant chemotherapy first, followed by chemoradiation and then surgery, in the management of locally advanced rectal cancer. J Natl Compr Cancer Netw. 2014;12:513–9.

    Article  Google Scholar 

  68. Nogué M, Salud A, Vicente P, et al. Addition of bevacizumab to XELOX induction therapy plus concomitant capecitabine-based chemoradiotherapy in magnetic resonance imaging-defined poor-prognosis locally advanced rectal cancer: the AVACROSS study. Oncologist. 2011;16:614–20.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Hong YS, Nam B-H, Kim K-P, et al. Oxaliplatin, fluorouracil, and leucovorin versus fluorouracil and leucovorin as adjuvant chemotherapy for locally advanced rectal cancer after preoperative chemoradiotherapy (ADORE): an open-label, multicentre, phase 2, randomised controlled trial. Lancet Oncol. 2014;15:1245–53.

    Article  CAS  PubMed  Google Scholar 

  70. Habr-Gama A, Perez RO, Sabbaga J, et al. Increasing the rates of complete response to neoadjuvant chemoradiotherapy for distal rectal cancer: results of a prospective study using additional chemotherapy during the resting period. Dis Colon Rectum. 2009;52:1927–34.

    Article  PubMed  Google Scholar 

  71. Nilsson PJ, van Etten B, Hospers GAP, et al. Short-course radiotherapy followed by neo-adjuvant chemotherapy in locally advanced rectal cancer--the RAPIDO trial. BMC Cancer. 2013;13:279.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  72. Gao Y-H, Lin J-Z, An X, et al. Neoadjuvant sandwich treatment with Oxaliplatin and Capecitabine administered prior to, concurrently with, and following radiation therapy in locally advanced rectal cancer: a prospective phase 2 trial. Int J Radiat Oncol Biol Phys. 2014;90:1153–60.

    Article  CAS  PubMed  Google Scholar 

  73. Guillem JG, Chessin DB, Shia J, et al. Clinical examination following preoperative chemoradiation for rectal cancer is not a reliable surrogate end point. J Clin Oncol. 2005;23:3475–9.

    Article  PubMed  Google Scholar 

  74. Radovanovic Z, Breberina M, Petrovic T, et al. Accuracy of endorectal ultrasonography in staging locally advanced rectal cancer after preoperative chemoradiation. Surg Endosc. 2008;22:2412–5.

    Article  PubMed  Google Scholar 

  75. Huh JW, Park YA, Jung EJ, et al. Accuracy of endorectal ultrasonography and computed tomography for restaging rectal cancer after preoperative chemoradiation. J Am Coll Surg. 2008;207:7–12.

    Article  PubMed  Google Scholar 

  76. Shanmugan S, Arrangoiz R, Nitzkorski JR, et al. Predicting pathological response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer using 18FDG-PET/CT. Ann Surg Oncol. 2012;19:2178–85.

    Article  PubMed  Google Scholar 

  77. Yoon H, Kim S, Kim T-S, et al. New application of dual point 18F-FDG PET/CT in the evaluation of neoadjuvant chemoradiation response of locally advanced rectal cancer. Clin Nucl Med. 2013;38:7–12.

    Article  PubMed  Google Scholar 

  78. Capirci C, Rampin L, Erba PA, et al. Sequential FDG-PET/CT reliably predicts response of locally advanced rectal cancer to neo-adjuvant chemo-radiation therapy. Eur J Nucl Med Mol Imaging. 2007;34:1583–93.

    Article  CAS  PubMed  Google Scholar 

  79. Perez RO, Habr-Gama A, Gama-Rodrigues J, et al. Accuracy of positron emission tomography/computed tomography and clinical assessment in the detection of complete rectal tumor regression after neoadjuvant chemoradiation: long-term results of a prospective trial (National Clinical Trial 00254683). Cancer. 2012;118:3501–11.

    Article  PubMed  Google Scholar 

  80. Elmi A, Hedgire SS, Covarrubias D, et al. Apparent diffusion coefficient as a non-invasive predictor of treatment response and recurrence in locally advanced rectal cancer. Clin Radiol. 2013;68:e524–31.

    Article  CAS  PubMed  Google Scholar 

  81. Song I, Kim SH, Lee SJ, et al. Value of diffusion-weighted imaging in the detection of viable tumour after neoadjuvant chemoradiation therapy in patients with locally advanced rectal cancer: comparison with T2 weighted and PET/CT imaging. Br J Radiol. 2012;85:577–86.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  82. Ha HI, Kim AY, Yu CS, et al. Locally advanced rectal cancer: diffusion-weighted MR tumour volumetry and the apparent diffusion coefficient for evaluating complete remission after preoperative chemoradiation therapy. Eur Radiol. 2013;23:3345–53.

    Article  PubMed  Google Scholar 

  83. Kim SH, Lee JY, Lee JM, et al. Apparent diffusion coefficient for evaluating tumour response to neoadjuvant chemoradiation therapy for locally advanced rectal cancer. Eur Radiol. 2011;21:987–95.

    Article  PubMed  Google Scholar 

  84. Patel UB, Taylor F, Blomqvist L, et al. Magnetic resonance imaging-detected tumor response for locally advanced rectal cancer predicts survival outcomes: MERCURY experience. J Clin Oncol. 2011;29:3753–60.

    Article  PubMed  Google Scholar 

  85. Patel UB, Brown G, Rutten H, et al. Comparison of magnetic resonance imaging and histopathological response to chemoradiotherapy in locally advanced rectal cancer. Ann Surg Oncol. 2012;19:2842–52.

    Article  PubMed  Google Scholar 

  86. Goldberg N, Kundel Y, Purim O, et al. Early prediction of histopathological response of rectal tumors after one week of preoperative radiochemotherapy using 18 F-FDG PET-CT imaging. A prospective clinical study. Radiat Oncol. 2012;7:124.

    Article  PubMed  PubMed Central  Google Scholar 

  87. Neuman HB, Patil S, Fuzesi S, et al. Impact of a temporary stoma on the quality of life of rectal cancer patients undergoing treatment. Ann Surg Oncol. 2011;18:1397–403.

    Article  PubMed  Google Scholar 

  88. Messaris E, Sehgal R, Deiling S, et al. Dehydration is the most common indication for readmission after diverting ileostomy creation. Dis Colon Rectum. 2012;55:175–80.

    Article  PubMed  Google Scholar 

  89. Glynne-Jones R, Harrison M, Hughes R. Challenges in the neoadjuvant treatment of rectal cancer: balancing the risk of recurrence and quality of life. Cancer Radiother. 2013;17:675–85.

    Article  CAS  PubMed  Google Scholar 

  90. Glimelius B, Tiret E, Cervantes A, et al. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24:vi81–8.

    Article  PubMed  Google Scholar 

  91. Smith N, Brown G. Preoperative staging of rectal cancer. Acta Oncol (Madr). 2008;47:20–31.

    Article  Google Scholar 

  92. Chang GJ, Park IJ, Eng C, et al. Exploratory analysis of adjuvant chemotherapy benefits after preoperative chemoradiotherapy and radical resection for rectal cancer. ASCO Meet Abstr. 2012;30:3556.

    Google Scholar 

  93. Fietkau R, Barten M, Klautke G, et al. Postoperative chemotherapy may not be necessary for patients with ypN0-category after neoadjuvant chemoradiotherapy of rectal cancer. Dis Colon Rectum. 2006;49:1284–92.

    Article  PubMed  Google Scholar 

  94. Maas M, Nelemans PJ, Valentini V, et al. Adjuvant chemotherapy in rectal cancer: defining subgroups who may benefit after neoadjuvant chemoradiation and resection: a pooled analysis of 3,313 patients. Int J Cancer. 2014;137:212–20.

    Article  PubMed  PubMed Central  Google Scholar 

  95. Taylor FGM, Quirke P, Heald RJ, et al. Preoperative high-resolution magnetic resonance imaging can identify good prognosis stage I, II, and III rectal cancer best managed by surgery alone: a prospective, multicenter. European Study Ann Surg. 2011;253:711–9.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Jenifer Levin, editor in the Colorectal Surgery Service at Memorial Sloan Kettering Cancer Center, for her assistance in editing this chapter.

Disclosures

The authors have nothing to disclose.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Julio Garcia-Aguilar .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Chow, O.S., Garcia-Aguilar, J. (2018). Maximizing Neoadjuvant Treatment Response and Watch and Wait. In: Chang, G. (eds) Rectal Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-16384-0_18

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-16384-0_18

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-16383-3

  • Online ISBN: 978-3-319-16384-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics