Watchful Waiting after Radiochemotherapy in Rectal Cancer: When Is It Feasible?

Abstract

A “watch and wait” strategy in rectal cancer is increasingly considered in patients who achieve an excellent response to radiotherapy. While a growing number of studies have shown the feasibility of this strategy in selected patients, the optimal therapeutic regimen to maximize response rates still needs to be established. Furthermore, accurate response prediction and the management of minor residual findings after radiotherapy remain a matter of debate. Finally, concerns regarding the long-term oncological safety of the “watch and wait” approach have been expressed. Therefore, the present review aims to address the open questions in the context of a “watch and wait” strategy and focuses on the diagnosis of a clinical complete response and the ideal management thereafter.

Clinical Reality and Treatment for Local Recurrence of Rectal Cancer: A Single-Center Retrospective Study

“…Modern management is adjusted to individual clinical cases it is based on preoperative diagnostics and is a result of conclusions from the publications of the last 3 decades. In recent years, there has been a tendency to increase the interval between preoperative radiotherapy and surgery, which is aimed to reduce the number of surgical complications [ 15 ] or even allow for the diagnosis of complete clinical response [ 16 ].…”

Value of PET imaging for radiation therapy

“…Usually, the entire target volume receives a uniform dose, such that a highly precise delineation of the primary tumour is not of clinical relevance. However, clinical trials are currently investigating whether dose escalation to the primary tumour can lead to an increase in complete remission rates and thus allow for an organ-preserving approach in a larger number of patients [103]. Here, a precise definition of the primary tumour is relevant to apply the highest possible dose to the primary tumour while sufficiently sparing normal tissue.…”

Value of PET imaging for radiation therapy

“…Usually, the entire target volume receives a uniform dose, such that a highly precise delineation of the primary tumour is not of clinical relevance. However, clinical trials are currently investigating whether dose escalation to the primary tumour can lead to an increase in complete remission rates and thus allow for an organ-preserving approach in a larger number of patients [103].…”