Watch-and-wait approach feasible following adjuvant therapy for rectal cancer

Patients with rectal cancer managed conservatively following a complete response (CR) to chemoradiotherapy (CRT) achieve similar rates of disease control as those who undergo rectal resection, research shows.

After a median of 28 months' follow up, just six of 32 patients managed nonoperatively had a local recurrence (LR).

All six patients were controlled with salvage rectal resection with no further evidence of disease recurrence.

"Our experience confirms that in well-selected patients, the 'watch and wait strategy' is readily accepted by patients and appears to have good intermediate-term results," report Philip Paty (Memorial Sloan-Kettering Cancer Center, New York, USA) and colleagues in the Annals of Surgery.

Paty and colleagues reviewed the outcomes of patients managed with selective nonoperative management after a clinical CR to neoadjuvant therapy.

Thirty-two patients were managed medically following CRT. The outcomes were compared with 265 patients treated with neoadjuvant therapy and rectal resection.

The nonoperative management was "presented as a departure from standard management, and was not done under the direction of a standardized policy," write Paty et al.

The decision was influenced by advanced age, severe medical comorbidity, or strong resistance to surgery on the part of the patient, mainly a desire to avoid the long-term morbidity of a rectal resection.

Compared with the six recurrences among the patients managed without surgery, there were no LRs among those who underwent rectal resection following CRT.

The data suggest that the critical timeframe for an isolated LR is in the first 14 months after CRT, say the researchers.

Overall, 2-year disease-free survival was 88% in the nonoperative group and 98% in the conventional surgery arm, a nonsignificant difference.

Rates of overall survival did not significantly differ between the groups, at 96% in the nonoperative arm and 100% in the surgery arm.

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