7 or 11 weeks after neoadjuvant radiochemotherapy? GRECCAR-6 trial
Posted in Lectures on 23 January 2018
Jeremie Lefevre MD PhD
Professor of General Surgery
Hôpitaux Universitaires Est Parisien
During the European Society of Coloproctology (ESCP) meeting held in September in Berlin, Dr. Lefevre addressed the topic of the optimal waiting period between the end of the neoadjuvant treatment for rectal cancer and the surgery. Based on the data in the paper on the GRECCAR-6 trial published in 2016, the author gives an excellent background on the subject and expounds the findings of the trial in an attempt to cast light on the topic.
In the GRECCAR-6 trial published in the Journal of Clinical Oncology i2016, the effect of neoadjuvant treatment at 7 weeks is compared to 11 weeks of waiting period in a multicenter, randomized, clinical trial. Patients had T3-T4N0 or N+ mid or low rectal cancer. The primary endpoint was to evaluate the rate of pathological complete response after neoadjuvant treatment.
The study did not show any difference between both two groups in regards to the rate of pathological response after radiochemotherapy. The significant parameters found were a worse rate of complete mesorectum, and overall morbidity at 11 weeks. As expected, patients presenting with a complete pathological response had better oncological outcomes than the rest.
In conclusions, waiting 11 weeks for surgery does not increase the rate of complete pathological response, and has no impact on tumoral characteristics or the overall survival rate when compared to a 7-week wait.