Wait-and-see treatment strategies for rectal cancer patients with clinical complete response after neoadjuvant chemoradiotherapy: a systematic review and meta-analysis

// Jun Li 1 , Lunjin Li 2 , Lin Yang 3 , Jiatian Yuan 1 , Bo Lv 1 , Yanan Yao 4 and Shasha Xing 5 1 General Surgery Department and Central Laboratory, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, People’s Republic of China 2 Pharmacy Department, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, People’s Republic of China 3 Department of Pathology, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China 4 Department of General Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China 5 Central Laboratory, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, People’s Republic of China Correspondence to: Jun Li, email: // Lunjin Li, email: // Lin Yang, email: // Keywords : rectal cancer, clinical complete response, neoadjuvant chemoradiotherapy, wait-and-see Received : December 14, 2015 Accepted : March 28, 2016 Published : April 06, 2016 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.