Non-operative management in low-lying rectal cancers undergoing chemoradiation

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Neoadjuvant chemoradiation (NACTRT) is standard for distal rectal cancers.
• Complete or near-complete response (cCR/nCR) allows for consideration of non-operative management.
• The wait-and-watch strategy (WWS) aims to preserve organs by avoiding immediate surgery.

Purpose of the Study:

• To evaluate the outcomes of the wait-and-watch strategy (WWS) in distal rectal cancer patients post-neoadjuvant chemoradiation (NACTRT).
• To assess organ preservation rate (OPR), local regrowth rate (LRR), recurrence-free survival (NR-RFS), and overall survival (OS).

Main Methods:

• Retrospective analysis of 61 distal rectal cancer patients achieving cCR or nCR post-NACTRT.
• Patients opted for WWS and were monitored via MRI, sigmoidoscopy, and DRE.
• Kaplan-Meier method used for survival analysis; log-rank test for factor association with LRR.

Main Results:

• At median 39-month follow-up, 11% experienced local regrowth, with most salvaged by surgery.
• Overall organ preservation rate (OPR) was 83%, non-regrowth recurrence-free survival (NR-RFS) was 95%, and overall survival (OS) was 98%.
• Local regrowth rate (LRR) was higher in patients with near-complete response (nCR) versus complete response (cCR) (P=0.05).

Conclusions:

• The wait-and-watch strategy (WWS) is a safe, non-operative management option for selected distal rectal cancer patients.
• Excellent organ preservation and survival outcomes are achievable with WWS after NACTRT.
• WWS provides a viable alternative for patients achieving cCR/nCR who wish to avoid surgery.