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Watchful Waiting after Radiochemotherapy in Rectal Cancer: When Is It Feasible?

ABSTRACT: A "watch and wait" strategy in rectal cancer is increasingly considered in patients who achieve an excellent response to radiotherapy. While a growing number of studies have shown the feasibility of this strategy in selected patients, the optimal therapeutic regimen to maximize response rates still needs to be established. Furthermore, accurate response prediction and the management of minor residual findings after radiotherapy remain a matter of debate. Finally, concerns regarding the long-term oncological safety of the "watch and wait" approach have been expressed. Therefore, the present review aims to address the open questions in the context of a "watch and wait" strategy and focuses on the diagnosis of a clinical complete response and the ideal management thereafter.

SUBMITTER: Gani C

PROVIDER: S-EPMC6514498 | biostudies-literature | 2019 Apr

REPOSITORIES: biostudies-literature

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Watchful Waiting after Radiochemotherapy in Rectal Cancer: When Is It Feasible?

Gani Cihan C Kirschniak Andreas A Zips Daniel D

Visceral medicine 20190327 2

A "watch and wait" strategy in rectal cancer is increasingly considered in patients who achieve an excellent response to radiotherapy. While a growing number of studies have shown the feasibility of this strategy in selected patients, the optimal therapeutic regimen to maximize response rates still needs to be established. Furthermore, accurate response prediction and the management of minor residual findings after radiotherapy remain a matter of debate. Finally, concerns regarding the long-term ...[more]

PMID: 31192245

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Project description: Not available

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Adenotonsillectomy or watchful waiting in the management of childhood obstructive sleep apnea.

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The outcome of watchful waiting in patients with previously treated follicular lymphoma.

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| S-EPMC1865439 | biostudies-literature

Surgery versus watchful waiting in patients with craniofacial fibrous dysplasia--a meta-analysis.

Project description:BackgroundFibrous dysplasia (FD) is a benign bone tumor which most commonly involves the craniofacial skeleton. The most devastating consequence of craniofacial FD (CFD) is loss of vision due to optic nerve compression (ONC). Radiological evidence of ONC is common, however the management of this condition is not well established. Our objective was to compare the long-term outcome of patients with optic nerve compression (ONC) due to craniofacial fibrous dysplasia (CFD) who either underwent surgery or were managed expectantly.Methodology/principal findingsWe performed a meta-analysis of 27 studies along with analysis of the records of a cohort of patients enrolled in National Institutes of Health (NIH) protocol 98-D-0145, entitled Screening and Natural History of Fibrous Dysplasia, with a diagnosis of CFD. The study group consisted of 241 patients; 122 were enrolled in the NIH study and 119 were extracted from cases published in the literature. The median follow-up period was 54 months (range, 6-228 months). A total of 368 optic nerves were investigated. All clinically impaired optic nerves (n?=?86, 23.3%) underwent therapeutic decompression. Of the 282 clinically intact nerves, 41 (15%) were surgically decompressed and 241 (85%) were followed expectantly. Improvement in visual function was reported in fifty-eight (67.4%) of the clinically impaired nerves after surgery. In the intact nerves group, long-term stable vision was achieved in 31/45 (75.6%) of the operated nerves, compared to 229/241 (95.1%) of the non-operated ones (p?=?0.0003). Surgery in asymptomatic patients was associated with visual deterioration (RR 4.89; 95% CI 2.26-10.59).ConclusionsMost patients with CFD will remain asymptomatic during long-term follow-up. Expectant management is recommended in asymptomatic patients even in the presence of radiological evidence of ONC.

| S-EPMC3179490 | biostudies-literature

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