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Watch-and-Wait Compared to Operation for Patients with Complete Response to Neoadjuvant Therapy for Rectal Cancer
Bryce W Beard1, Robert L Rettig2, Joan J Ryoo1
1Departments of Radiation Oncology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA.
Journal of the American College of Surgeons
|October 30, 2020
Summary
Watch-and-wait (WW) is a safe option for rectal cancer patients with a complete response to neoadjuvant chemoradiation (nCRT). This approach avoids surgery, offering comparable survival outcomes and feasibility for select patients.
Area of Science:
- Oncology
- Surgical Oncology
- Gastroenterology
Background:
- Standard treatment for locally advanced rectal cancer involves trimodality therapy: neoadjuvant chemoradiation (nCRT), surgery, and adjuvant chemotherapy.
- A subset of patients achieving a complete response (CR) to nCRT may be candidates for a non-operative approach, termed watch-and-wait (WW).
Purpose of the Study:
- To compare the outcomes of the watch-and-wait (WW) strategy with traditional surgery in patients who achieved a complete response (CR) after neoadjuvant chemoradiation (nCRT).
Main Methods:
- Retrospective review of nonmetastatic rectal cancer patients treated with nCRT.
- Definition of complete endoscopic response (CER) and clinical complete response (cCR) based on physical exam, endoscopy, and MRI.
- Comparison of oncologic outcomes between patients managed with WW and those who underwent surgery.
Main Results:
- Of 465 patients completing nCRT, 95 (23%) achieved CER. 53 patients opted for WW, and 42 had surgery.
- The 3-year freedom from local regrowth was 85% in the WW group.
- While overall survival was similar, the WW group showed a trend towards lower rectal cancer-specific survival and freedom from nonregrowth recurrence compared to the surgical group, though not statistically significant in all measures.
Conclusions:
- Watch-and-wait (WW) is a safe and feasible alternative to surgery for rectal cancer patients achieving a clinical complete response (cCR) after neoadjuvant chemoradiation (nCRT).
- Accurate assessment for cCR is crucial for selecting appropriate candidates for the WW strategy.
