The watch-and-wait strategy versus surgical resection for rectal cancer patients with a clinical complete response after neoadjuvant chemoradiotherapy

Abstract

Background The watch-and-wait strategy offers a non-invasive therapeutic alternative for rectal cancer patients who have achieved a clinical complete response (cCR) after chemoradiotherapy. This study aimed to investigate the long-term clinical outcomes of this strategy in comparation to surgical resection. Methods Stage II/III rectal adenocarcinoma patients who received neoadjuvant chemoradiotherapy and achieved a cCR were selected from the databases of three centers. cCR was evaluated by findings from digital rectal examination, colonoscopy, and radiographic images. Patients in whom the watch-and-wait strategy was adopted were matched with patients who underwent radical resection through 1:1 propensity score matching analyses. Survival was calculated and compared in the two groups using the Kaplan–Meier method with the log rank test. Results A total of 117 patients in whom the watch-and-wait strategy was adopted were matched with 354 patients who underwent radical resection. After matching, there were 94 patients in each group, and no significant differences in term of age, sex, T stage, N stage or tumor location were observed between the two groups. The median follow-up time was 38.2 months. Patients in whom the watch-and-wait strategy was adopted exhibited a higher rate of local recurrences (14.9% vs. 1.1%), but most (85.7%) were salvageable. Three-year non-regrowth local recurrence-free survival was comparable between the two groups (98% vs. 98%, P = 0.506), but the watch-and-wait group presented an obvious advantage in terms of sphincter preservation, especially in patients with a tumor located within 3 cm of the anal verge (89.7% vs. 41.2%, P < 0.001). Three-year distant metastasis-free survival (88% in the watch-and-wait group vs. 89% in the surgical group, P = 0.874), 3-year disease-specific survival (99% vs. 96%, P = 0.643) and overall survival (99% vs. 96%, P = 0.905) were also comparable between the two groups, although a higher rate (35.7%) of distant metastases was observed in patients who exhibited local regrowth in the watch-and-wait group. Conclusion The watch-and-wait strategy was safe, with similar survival outcomes but a superior sphincter preservation rate as compared to surgery in rectal cancer patients achieving a cCR after neoadjuvant chemoradiotherapy, and could be offered as a promising conservative alternative to invasive radical surgery.

Watch and Wait Approach for Rectal Cancer Following Neoadjuvant Treatment: The Experience of a High Volume Cancer Center

“…In our experience, the mean time to the local regrowth during follow-up was 20.8 months (range 10-31 months), with a higher rate of local recurrences within three years compared to surgical groups (15.3% vs. 2.9% and 9.5%). This seems to be lower than results from other authors who reported a larger data series of w&w strategy [12,[29][30][31], and higher than a multicentric registry study [32] with a very large follow-up.…”

A meta-analysis of the watch-and-wait strategy versus total mesorectal excision for rectal cancer exhibiting complete clinical response after neoadjuvant chemoradiotherapy

“…1 ). After the literature screening, a total of nine studies with 818 patients were included [ 16 – 24 ]. A total of 339 patients were in the W&W group, and 479 patients were in the TME group.…”

Acute Radiation Syndrome and the Microbiome: Impact and Review

“…Although the discovery and use of the 16S rRNA gene have greatly expanded microbiome research, it is still only bacterially selective, limiting this sequencing technique to evaluation of bacterial composition and responses to environmental changes or challenges ( Bäckhed et al, 2005 ). Investigation of the virome, mycobiome, and archaea components of the microbiota broadly and particularly in response to radiation has been lacking ( Rosenberg and Zilber-Rosenberg, 2013 ; Roy and Trinchieri, 2017 ; Liu et al, 2021 ). It is possible that broader insights into the impact of nonbacterial components of the GI microbiota might be obtained through non-targeted shotgun metagenomic sequencing techniques that would be capable of assessing radiation responses in the nonbacterial compartments of the GI microbiota ( Campo et al, 2020 ; Kaźmierczak-Siedlecka et al, 2020 ; Turkington et al, 2021 ).…”

“…As noted above, most studies of the effect of radiation on the GI microbiome have been conducted in the context of cancer radiotherapy, and recent reviews summarize the literature in that context ( Liu et al, 2021 ; Tonneau et al, 2021 ). Indeed, therapeutic abdominopelvic radiation exposure frequently results in intestinal dysfunction and dysbiosis, with acute radiation enteritis complications observed in 50% or more of abdominally irradiated cancer patients ( Touchefeu et al, 2014 ).…”