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Watch & wait - Post neoadjuvant imaging for rectal cancer.

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The watch-and-wait (WW) strategy offers organ preservation for rectal cancer patients achieving a complete response after total neoadjuvant therapy (TNT). Rigorous surveillance, including MRI, is crucial due to potential local regrowth within two years.

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Area of Science:

  • Oncology
  • Gastroenterology
  • Radiology

Background:

  • Rectal cancer management has advanced with total neoadjuvant therapy (TNT).
  • The watch-and-wait (WW) strategy is an emerging organ-preserving approach for complete responders.
  • WW strategy aims to maintain rectal function and quality of life without compromising outcomes.

Purpose of the Study:

  • To review the evidence supporting the watch-and-wait (WW) strategy in rectal cancer.
  • To highlight the critical role of restaging magnetic resonance imaging (MRI) in patient selection for WW.
  • To discuss MRI protocols and interpretation for assessing treatment response in the WW context.

Main Methods:

  • Review of current evidence on the WW strategy for rectal cancer.
  • Analysis of the OPRA trial's 5-year results regarding organ preservation and local regrowth.
  • Discussion of magnetic resonance imaging (MRI) techniques for restaging and surveillance.

Main Results:

  • Approximately 50% of patients achieve organ preservation with the WW strategy.
  • Most local regrowth events occur within the first two years of surveillance.
  • Rigorous clinical and radiographic surveillance is essential for successful WW implementation.

Conclusions:

  • The WW strategy is a viable organ-preservation option for select rectal cancer patients post-TNT.
  • Restaging rectal MRI is pivotal for determining eligibility and monitoring patients on the WW strategy.
  • Standardized MRI protocols and careful assessment are necessary to optimize WW outcomes.