Complete clinical response after neoadjuvant chemoradiation therapy for XXXX : characterization of clinical and endoscopic findings for standardization.

@entity1 @entity4181 @entity5 @entity1066 @entity1487
BACKGROUND: Complete @entity5 regression may develop after neoadjuvant chemoradiation therapy for @entity5 . Studies have suggested that selected @entity1 with complete clinical response may avoid radical surgery and close surveillance may provide good outcomes with no oncologic compromise. However, definition of complete clinical response is often imprecise and may vary between different studies. The aim of this study is to provide a clear definition for a complete clinical response after neoadjuvant chemoradiation therapy in @entity1 with @entity5 in addition to actual endoscopic videos from @entity1 managed nonoperatively. METHODS: @entity1 with nonmetastatic @entity5 treated by neoadjuvant chemoradiation therapy, including 50.4 Gy and concomitant @entity1487 and @entity4181 , were assessed for @entity5 response at least 8 weeks after chemoradiation therapy completion. Complete and incomplete clinical responses were defined based on clinical and endoscopic findings. @entity1 with complete clinical response were not immediately operated on and were closely followed. Early and late endoscopic findings were recorded. RESULTS: Definition of a complete clinical response should be based on very strict clinical and endoscopic criteria. The finding of any residual superficial @entity1066 , irregularity, or nodule should prompt surgical attention, including transanal full-thickness excision or even a radical resection with total mesorectal excision. Standard or incisional biopsies should be avoided in this setting. Complete clinical responders should harbor no more than whitening of the mucosa, teleangiectasia with mucosal integrity to be considered for a nonoperative approach. In the presence of these findings, regularly scheduled reassessments may provide a safe alternative to these @entity1 with early detection of recurrent disease. CONCLUSION: Strict definition of the clinical and endoscopic findings of @entity1 experiencing complete clinical response after neoadjuvant chemoradiation therapy may provide a useful tool for the understanding of outcomes of @entity1 managed with no immediate surgery allowing standardization of classifications and comparison between the experiences of different institutions.
