Rectal cancer patients can be treated conservatively

Abstract

Introduction. The strategy of undertaking a watch-and-wait policy without surgical treatment is currently being debated in those patients where complete clinical response/regression (cCR) has been diagnosed after preoperative irradiation. Its proponents maintain that there is sufficient evidence of efficacy allowing routine use. This means that following preoperative chemoradiotherapy, each patient should be investigated for cCR. If so diagnosed, physicians are then obliged to give the patient the choice of two treatment options: surgical treatment or watch-and-wait without surgery. Radical surgical treatment is adopted as a rescue/salvage therapy if during the watch-and-wait period, local recurrence in patients occurs. In contrast, opponents of the strategy of watch-and-wait, purport that evidence for its efficacy is inadequate to justify routine use. Results. Literature data indicates that the rate of cCR depends on the tumour size, with incidence ranging between 5% and 78% of those patients irradiated prior to surgery. If the patients were kept under watch-and-wait without surgery, then the local recurrence rate was around 30%. Such high rates of local recurrences does not however disqualify this approach because the efficacy of rescue surgery was high. Distant metastases were rare, up 10% of patients, and survivals were even better compared to control patient groups who had been operated on due to not achieving cCR; this difference arising from the inherently less aggressive tumours that are sensitive to irradiation. Conclusions. The data hitherto indicate that a policy of watch-and-wait may be adopted in patients with CCR after chemoradiotherapy. Nevertheless, introducing this strategy requires acquiring experience for diagnosing CCR and an efficient organisation and supervision of treatment along with the rigorous follow-up. NOWOTWORY J Oncol 2017; 67, 2: 146-151

Nonsurgical Management of Rectal Cancer

“…22 Distant metastatic disease with nonsurgical management is approximately 8% to 10%. 22,27,44 In most studies, local recurrence was managed by salvage surgical resection, and up to 95.4% of patients received salvage therapy. 23 For example, six of 26 patients under nonsurgical management developed local recurrence in the first 2 years, and all underwent salvage surgical resection with total mesorectal excision with five of six patients achieving R0 resection in the retrospective study by Smith et al 20 In another study, local recurrence was observed in one of 18 patients in the first year of surveillance and was treated by transanal endoscopic surgery with positive margins; the patient then underwent successful abdominoperineal resection.…”