Is Early, Post-Induction Restaging of Rectal Cancer Undergoing Total Neoadjuvant Therapy Associated With Ultimate Treatment Response?

William C. Chapman, Emre Gorgun, Sumeyye Yilmaz, David R. Rosen, Michael Valente, Josh Sommovilla, Arielle Kanters, Andrei Purysko, Alok Khorana, Smitha Krishnamurthi, Sudha Amarnath, Hermann Kessler, Scott Steele, David Liska

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Among rectal cancer patients treated with Total Neoadjuvant Therapy, it is unclear whether early, post-induction restaging is associated with final tumor response. If so, interim restaging may alter rectal cancer decision-making. OBJECTIVE: To determine if post-induction restaging with endoscopy and magnetic resonance imaging is associated with final tumor response. DESIGN: Retrospective cohort study SETTINGS: US tertiary care institution accredited by the National Accreditation Program for Rectal Cancer PATIENTS: Biopsy-proven rectal cancer patients who underwent Total Neoadjuvant Therapy with interim (post-induction) restaging. MAIN OUTCOME MEASURES: Association between response assessment on post-induction restaging and final treatment response. RESULTS: 107 patients were analyzed. Patients with post-induction magnetic resonance tumor response grade 1 - 2 or complete endoscopic response were significantly more likely (odds ratio 5.4 [p < 0.01] and odds ratio 3.7 [p = 0.03], respectively) to ultimately achieve a final complete response. Likewise, the odds of a final incomplete response were significantly higher for patients with post-induction composite partial (odds ratio 4.1, p < 0.01) or minimal (odds ratio 12.0, p < 0.01) responses. LIMITATIONS: Retrospective analysis and lack of detailed subclassification of partial endoscopic response may have limited the conclusions of this data. Limited sample size may also have biased these conclusions. CONCLUSION: Tumor response to induction therapy is associated with ultimate treatment response to Total Neoadjuvant Therapy among complete or minimal responders; the significance of a partial interim response remains unclear.

Original languageEnglish
Article number10.1097/DCR.0000000000003485
JournalDiseases of the Colon and Rectum
DOIs
StateAccepted/In press - 2024

Keywords

  • Complete response
  • Nonoperative management
  • Rectal cancer
  • Total neoadjuvant therapy
  • Watch-and-wait

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