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

Abstract

Multimodal treatments for rectal cancer, along with significant research on predictors to response to therapy, have led to more conservative surgical strategies. We describe our experience of the rectal sparing approach in rectal cancer patients with clinical complete response (cCR) after neoadjuvant treatment. We also specifically highlight our clinical and imaging criteria to select patients for the watch and wait strategy (w&w). Data came from 39 out of 670 patients treated for locally advanced rectal cancer between January 2016 until February 2020. The selection criteria were a clinical complete response after neoadjuvant chemotherapy managed with a watch and wait (w&w) strategy. A strict follow-up period was adopted in these selected patients and follow-ups were performed every three months during the first two years and every six months after that. The median follow-up time was 28 months. Six patients had a local recurrence (15.3%); all were salvageable by total mesorectal excision (TME). Five patients had a distant metastasis (12.8%). There was no local unsalvageable disease after w&w strategy. The rectal sparing approach in patients with clinical complete response after neoadjuvant treatment is the best possible treatment and is appropriate to analyze from this perspective. The watch and wait approach after neoadjuvant treatment for rectal cancer can be successfully explored after inflexible and strict patient selection.

Total neoadjuvant treatment (consolidation chemotherapy) provides highest rate of clinical complete response for rectal cancer: Median 5-year long-term oncological outcomes in patients with treated WW protocol

“…This result is crucial as it shows that tumors with early T stage are cleared at a higher rate after shorter waiting periods. In studies with long-course RT, but with a maximum waiting period of 8 weeks after RT, cCR rates ranged 11-19% [21][22][23]. A review [24], on a majority of studies with standard CRT protocol, reported that the waiting period for reassessment was with a wide range of 3-24 weeks and the cCR was shown to be 22.4% on average.…”

Electrochemotherapy of Primary Colon Rectum Cancer and Local Recurrence: Case Report and Prospective Analysis

“…The procedure was completed within 40 min from the end of the bleomycin injection [ 23 ]. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) were used to assess ECT response [ 6 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ]. In Table 1 , case descriptions and results are summarized.…”

Structured Reporting in Radiological Settings: Pitfalls and Perspectives

“…For example, during MRI rectal cancer staging [ 65 , 66 ], the templates should report all the relevant issues on primary lesions and nodal status, such as the circumferential resection margin’s (CRM) involvement, extramural venous invasion (EMVI), and tumor deposits, in order to define the proper patient treatment. For MRI rectal cancer restaging, all relevant issues are re-assessed [ 65 , 66 ] to define the treatment response and the proper patient therapeutic approach ( Figure 4 ), (i.e., total mesorectal excision, versus the “wait and watch” approach) [ 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 ].…”