Table 2.
Chemoradiation and observation (nonoperative management)
| Authors (reference) | N | Age (y) | f/u (mo) | Stage | RT | Chemotherapy | cCR, n (%) |
|---|---|---|---|---|---|---|---|
|
| |||||||
| Habr-Gama et al (2004) (66) | 265 | Mean 54.8 (range, 25–92) | Mean 50.5 | Stage I-III, resectable | 50.4 Gy @ 180 cGy/fx | 5-FU and folinic acid | 71 (26.8) |
| Dalton et al (70) | 49 | Median 64 | Mean 25.5 | T3–4N0–2 | 45 Gy in 25 fx | Capecitabine | 6 (12.2) |
| Maas et al (71) | 192 | Mean 65 | Mean 25 | Stage I-III | 50.4 Gy @ 180 cGy/fx | Capecitabine | 21 (10.9) |
| Smith et al (72) | N/A | Median 70 | Median 28 | T2–4N0–2 | 50.4 Gy (median dose) | 5-FU or capecitabine | 32 |
| Habr-Gama et al (2013)(73) | 70 | Mean 60.2 | Median 56 | T2–4N0–2 | 54 Gy @ 180 cGy/fx | 5-FU and folinic acid | 47 (68) |
| Appelt et al (74) | 51 | Median 67 | Median 23.9 | T2–3N0–1 | 60 Gy in 30 fx + 5 Gy brachytherapy boost | Tegafur-uracil | 40 (78.4) |
| Araujo et al (75) | N/A | Median 63.6 | Median 47.7 | LARC | 45–50.4 Gy | 5-FU and leucovorin | 42 |
| Renehan et al (68) | N/A | Median 66.9 | Median 33 | Stage I-III | 45 Gy | Capecitabine | 129 |
| Response assessment (timing*) | Adjuvant chemotherapy after cCR, n (%) | LF after cCR, n (%) | DF after cCR, n (%) | Salvage after LF, n (%) | Survival (cCR cohort) (%) |
|---|---|---|---|---|---|
|
| |||||
| Proctoscopy, rebiopsy, DRE, CT A/P, chest X-ray (8 wk) | None | 2 (2.8) | 3 (4.2) | 2 (100) | 10-y OS, 97.7; 10-y DFS, 84 |
| MRI, EUA, rebiopsy, PET/CT (6–8 wk) | None | 0 | 0 | N/A | N/A |
| MRI, DRE, endoscopy, rebiopsy (6–8 wk) | 17 (81) | 1 (4.8) | 0 | 1 (100) | 2-y OS, 100; 2-yDFS, 89 |
| DRE, endoscopy, selective biopsy (4–10 wk) | 17 (53) | 6 (18.8) | 3 (9.4) | 6 (100) | 2-y OS, 97; 2-y DFS, 88 |
| DRE, proctoscopy, CEA, MRI, and/or | None | 12 (25.5) | 3 (6.4) | 11 (91.7) | 3-y OS, 94; 3-y DFS, 75 |
| PET/CT (10 wk) | |||||
| DRE, endoscopy, rebiopsy, MRI pelvis | None | 9 (22.5) | 3 (7.5) | 9 (100) | N/A |
| (6 wk) | |||||
| MRI, DRE, endoscopy (not stated) | 2 (4.8) | 8 (19.0) | 7 (16.7) | 4(50) | 5-y OS, 71.6; 5-y |
| DFS, 60.9 | |||||
| MRI pelvis, DRE, endoscopy (≥8 wk) | 8(6) | 44 (34.1) | 7 (5.4) | 37 (84.1) | 3-y OS, 96; 3-y DFS, 88 |
Abbreviations: 5-FU = 5-fluorouracil; cCR = clinical complete response; CEA = carcinoembiyonic antigen; CT A/P = computed tomography abdomen and pelvis; DF = distant failure; DFS = disease-free survival; DRE = digital rectal examination; EUA = examination under anesthesia; f/u = follow-up; fx = fractions; LARC = locally advanced rectal cancer; LF = local failure; OS = overall survival; N/A = not available; PET = positron emission tomography.
*
Timing of clinical response assessment after completion of chemoradiation.