High-dose chemoradiotherapy and watchful waiting might be a safe alternative to abdominoperineal resection for the treatment of patients with distal rectal cancer, a new study published online ahead of print in the journal The Lancet Oncology has shown.

The standard approach for the treatment of patients with distal T2 or T3 rectal cancers is abdominoperineal resection, but that procedure has various drawbacks.

Therefore, researchers sought to investigate whether high-dose radiotherapy plus concomitant chemotherapy followed by watchful waiting was a successful alternative strategy.

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Researchers enrolled 55 patients with primary, resectable, T2 or T3, N0-N1 adenocarcinoma in the lower 6 cm of the rectum.

All patients received chemoradiotherapy every weekday for 6 weeks. If patients then achieved a clinical complete response, they were allocated to watchful waiting and those who did not received standard surgery.

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Results showed that of the 51 evaluable patients, 40 achieved a clinical complete response and went on to be observed. Researchers found that the 1-year local tumor recurrence rate in the watchful waiting group was 15.5% (95% CI: 3.3, 26.3).

In regard to safety, the most common acute grade 3 adverse event was diarrhea and the most common late toxicity was bleeding from the rectal mucosa. The study demonstrated excellent sphincter function among patients in the observation group.


  1. Appelt AL, Ploen J, Harling H, et al. High-dose chemoradiotherapy and watchful waiting for distal rectal cancer: a prospective observational study. The Lancet Oncol. 2015. [epub ahead of print]. doi: 10.1016/S1470-2045(15)00120-5.