Nonoperative management in low-lying rectal cancers undergoing chemoradiation

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Distal rectal cancer treatment often involves neoadjuvant chemoradiotherapy (NACTRT).
• A subset of patients achieve complete or near-complete response post-NACTRT.
• Nonsurgical management options are being explored for these patients.

Purpose of the Study:

• To evaluate the outcomes of the wait-and-watch strategy (WWS) in distal rectal cancer patients.
• To assess organ preservation rate (OPR), local regrowth rate (LRR), and survival after WWS.
• To identify factors associated with local regrowth in this cohort.

Main Methods:

• Retrospective analysis of 61 distal rectal cancer patients treated with NACTRT and WWS (2012-2019).
• Patients achieving complete clinical response (cCR) or near-complete response (nCR) were included.
• Follow-up included MRI, sigmoidoscopy, and DRE; survival outcomes analyzed using Kaplan-Meier method.

Main Results:

• 11% of patients experienced local regrowth, with most salvaged by surgery.
• High organ preservation rate (83%), nonregrowth recurrence-free survival (95%), and overall survival (98%) were observed.
• Local regrowth was associated with near-complete response (nCR) compared to complete response (cCR).

Conclusions:

• The wait-and-watch strategy is a safe and effective nonoperative option for selected distal rectal cancer patients with cCR/nCR post-NACTRT.
• This approach yields excellent organ preservation and survival outcomes.
• Careful patient selection and monitoring are crucial for successful WWS.