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Local Regrowth and the Risk of Distant Metastases Among Patients Undergoing Watch-and-Wait for Rectal Cancer: What Is
Guilherme Pagin São Julião1,2,3, Laura M Fernández4, Bruna Borba Vailati1,2,3
1Angelita and Joaquim Gama Institute, São Paulo, Brazil.
Diseases of the Colon and Rectum
|July 26, 2023
Summary
Patients with rectal cancer who achieve a clinical complete response and develop local regrowth have a higher risk of distant metastases compared to those managed with upfront surgery. This highlights the importance of monitoring after a watch-and-wait strategy.
Area of Science:
- Oncology
- Surgical Oncology
- Gastroenterology
Background:
- A subset of rectal cancer patients achieving clinical complete response (cCR) may experience local tumor regrowth.
- While salvage treatments offer local control, the risk of distant metastasis following regrowth is not well-established.
Purpose of the Study:
- To compare the risk of distant metastases in rectal cancer patients who achieve cCR, undergo a watch-and-wait strategy, and subsequently develop local regrowth versus those treated with upfront surgery after neoadjuvant chemoradiation.
Main Methods:
- Retrospective multicenter cohort study including patients treated between 1993 and 2019.
- Included patients with cCR followed by local regrowth and those with near-complete pathological response (≤10%) after upfront surgery post-chemoradiation.
- Univariate/multivariate analyses and Kaplan-Meier curves were used to assess risk factors and survival outcomes, with time zero defined as the end of radiation or salvage resection date.
Main Results:
- Patients with local regrowth (21/79) had a significantly higher incidence of distant metastases compared to those undergoing upfront surgery (10/74; p=0.04).
- Local regrowth and final pathology (ypT3-4) were identified as independent risk factors for distant metastases.
- Distant metastasis-free survival was significantly lower in the local regrowth group (70%) versus the upfront surgery group (86%; p=0.01) when using salvage resection date as time zero.
Conclusions:
- Rectal cancer patients managed with a watch-and-wait strategy who experience local regrowth face a heightened risk of developing distant metastases.
- This risk is greater when compared to patients with a near-complete pathological response who undergo upfront surgery following chemoradiation.
- Limitations include a small patient cohort, diverse neoadjuvant therapies, and potential selection bias.
