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The Ongoing Development of Watch and Wait.

Mikhael Belkovsky1, Ali Alipouriani2, Arielle E Kanters2

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This summary is machine-generated.

The watch and wait (W&W) approach for rectal cancer, using clinical complete response (cCR) after neoadjuvant chemoradiation (nCRT), shows high survival rates. This nonoperative strategy offers reduced morbidity for selected patients without compromising outcomes.

Keywords:
nonoperative managementrectal cancerwatch and wait

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Gastroenterology

Background:

  • Watch and wait (W&W) is an evolving nonoperative management strategy for rectal cancer.
  • It relies on achieving a clinical complete response (cCR) after neoadjuvant chemoradiation (nCRT) to predict pathological complete response (pCR).
  • Increasing efficacy of nCRT regimens has made W&W a feasible option for select patients.

Purpose of the Study:

  • To review the historical development and efficacy of the W&W strategy for rectal cancer.
  • To provide current recommendations for W&W based on recent clinical evidence.
  • To assess the oncological outcomes and quality of life implications of W&W.

Main Methods:

  • Literature review of historical and contemporary studies on W&W for rectal cancer.
  • Analysis of clinical trial data focusing on response rates and survival outcomes.
  • Evaluation of patient-reported outcomes and morbidity associated with W&W.

Main Results:

  • Achieving cCR after nCRT is a reliable indicator of pCR in W&W candidates.
  • Patients managed with W&W who achieve cCR demonstrate 5-year disease-free survival rates of 85-92%.
  • W&W offers a potential for significantly reduced treatment-related morbidity and improved quality of life.

Conclusions:

  • The watch and wait strategy is a safe and effective nonoperative option for rectal cancer patients achieving cCR post-nCRT.
  • W&W can preserve quality of life and reduce surgical morbidity without negatively impacting survival.
  • Continued research and standardized protocols are essential for optimizing W&W implementation.