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A Watch-and-Wait Approach to Rectal Cancer After Complete Response to Neoadjuvant Therapy

By: Andrew Goldstein
Posted: Monday, April 1, 2019

Patients diagnosed with rectal adenocarcinoma who followed a watch-and-wait strategy after complete clinical response to neoadjuvant therapy had a high rate of rectal preservation and pelvic tumor control. However, patients in the watch-and-wait group with local tumor regrowth had worse survival and a higher incidence of distant disease progression than did those who had pathologic complete response (pCR) after total mesorectal resection. These results are based on a study by J. Joshua Smith, MD, PhD, of Memorial Sloan Kettering Cancer Center, and colleagues, published in JAMA Oncology.

The study focused on 113 patients who had a clinical complete response and then began a watch-and-wait approach and 136 patients who underwent total mesorectal excision and had a pCR. Patients in the watch-and-wait cohort were a decade older on average and had disease closer to the anal verge.

After 5 years, overall survival was 73% in the watch-and-wait group and 94% in the pCR group; disease-free survival was 75% in the watch-and-wait group and 92% in the pCR group; and disease-specific survival was 90% in the watch-and-wait group and 98% in the pCR group.

Local regrowth occurred 22 times in the watch-and-wait group; each time, it was time detected on routine surveillance and treated by either total mesorectal excision or transanal excision. Pelvic control after salvage surgery was maintained in 20 of the 22 patients. Rectal preservation was achieved for 93 patients in the watch-and-wait group, 91 of whom had no local regrowth and 2 of whom had local regrowth salvaged with transanal excision.

Based on these study findings, the researchers concluded, “although watch-and-wait may be effective in most patients, better risk stratification is needed to inform more precise patient selection and to better understand which patients should be excluded from a watch-and-wait strategy to minimize local failure and distant progression.”

Disclosure: The study authors’ disclosure information may be found at jamanetwork.com.



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