title: Wait-and-see treatment strategies for rectal cancer patients with clinical complete response after neoadjuvant chemoradiotherapy: a systematic review and meta-analysis.
abstract: Wait-and-see treatment strategies may benefit rectal cancer patients who achieve a clinical complete response (cCR) after neoadjuvant chemoradiotherapy (NCRT). In this study, we analyzed data from 9 eligible trials to compare the oncologic outcomes of 251 rectal cancer patients achieving a cCR through nonsurgical management approaches with the outcomes of 344 patients achieving a pathologic complete response (pCR) through radical surgery. The two patient groups did not differ in distant metastasis rates or disease-free and overall survival, but the nonsurgical group had a higher risk of 1, 2, 3, and 5-year local recurrence. Hence, we concluded that for rectal cancer patients achieving a cCR after NCRT, a wait-and-see strategy with strict selection criteria, an appropriate follow-up schedule, and salvage treatments achieved outcomes at least as good as radical surgery. Long-term randomized and controlled trials with more uniform inclusion criteria and standardized follow-up schedules will help clarify the risks and benefits of wait-and-see treatment strategies for these patients.
authors.affiliation: General Surgery Department and Central Laboratory, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, People's Republic of China.
authors.forename: Jun
authors.initials: J
authors.lastname: Li
authors.affiliation: Pharmacy Department, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, People's Republic of China.
authors.forename: Lunjin
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Pathology, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
authors.forename: Lin
authors.initials: L
authors.lastname: Yang
authors.affiliation: General Surgery Department and Central Laboratory, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, People's Republic of China.
authors.forename: Jiatian
authors.initials: J
authors.lastname: Yuan
authors.affiliation: General Surgery Department and Central Laboratory, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, People's Republic of China.
authors.forename: Bo
authors.initials: B
authors.lastname: Lv
authors.affiliation: Department of General Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.
authors.forename: Yanan
authors.initials: Y
authors.lastname: Yao
authors.affiliation: Central Laboratory, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, People's Republic of China.
authors.forename: Shasha
authors.initials: S
authors.lastname: Xing
mesh_terms: D059248:Chemoradiotherapy; D006801:Humans; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy*; D012074:Remission Induction; D012307:Risk Factors; D016879:Salvage Therapy; D016019:Survival Analysis; D057832:Watchful Waiting
keywords: clinical complete response; neoadjuvant chemoradiotherapy; rectal cancer; wait-and-see