Bringing organ preservation closer for selected patients with rectal cancer
Mené entre 2015 et 2020 sur 148 patients atteints d'un adénocarcinome du bas-moyen rectum de stade précode (durée médiane de suivi : 38,2 mois), cet essai randomisé multicentrique de phase III évalue l'intérêt, du point de vue du taux de préservation des organes à 3 ans, d'ajouter une curiethérapie de type "boost" à une chimioradiothérapie néoadjuvante
Not all patients with rectal cancer require surgery after neoadjuvant treatment. Instead, for those with a clinical complete response (cCR) after neoadjuvant therapy, a watch and wait approach can be started. In up to 25% of patients managed in this way, the tumour recurs or persists, but a salvage total mesorectal excision can be performed without substantially jeopardising oncological outcomes for many of these patients. 1 , 2 The problem is that complete response after neoadjuvant treatment cannot be predicted in advance. As a general rule, smaller tumours or more intensive treatment increase the chance of cCR. 3 Organ preservation implies that surgical morbidity and mortality, especially in older and frail patients, can be avoided, as well as poor functional outcome due to surgical nerve damage (eg, impotence, micturition and defecation disorders, and the need for a permanent stoma), which can have a negative impact on quality of life. The downside is that preoperative radiotherapy might also result in substantial short-term and long-term morbidity, especially in patients who do not need preoperative treatment for their oncological treatment and could go straight for local excision or rectal resection. Overtreatment of these patients will lead to a higher frequency of surgical complications and poorer functional outcome.
The Lancet Gastroenterology & Hepatology , commentaire, 2022