A substantial proportion of patients with rectal cancer managed by the watch-and-wait approach avoided a major operation and averted permanent colostomy without differences in 3-year non-regrowth disease-free survival compared with patients who underwent surgical resection, a new study published online ahead of print in the journal The Lancet Oncology has shown.1
Although a watch-and-wait approach has emerged as a management strategy for patients with rectal cancer after they have achieved a clinical complete response with chemoradiotherapy, there is limited evidence evaluating the safety of this approach.
Therefore, researchers sought to compare oncological outcomes between patients managed by watch and wait who achieved a clinical complete response and those who underwent surgical resection.
For the ONCORE cohort analysis study, researchers included 259 patients diagnosed with rectal adenocarcinoma without distant metastases who had received preoperative chemoradiotherapy consisting of fluoropyrmidine-based chemotherapy.
Patients who achieved a complete clinical response were offered watch-and-wait management and patients who did not have a clinical complete response were offered surgical resection.
A total of 129 patients were managed by watch and wait. Of those, 34% had local regrowths and 88% of 41 patients with non-metastatic local regrowths were salvaged.
Researchers found no differences in 3-year non-regrowth disease-free survival between the watch-and-wait group and the surgical resection group (P = .043). There was also no difference in the 3-year overall survival rate between the 2 groups (P = .024).
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The study demonstrated that patients managed by watch and wait had significantly better 3-year colostomy-free survival compared with those who had undergone surgical resection (HR, 0.445; 95% CI, 0.31 – 0.64; P < .0001).
“These findings should inform decision making at the outset of chemotherapy,” the investigators concluded.
- Renehan AG, Malcomson L, Emsley R, et al. Watch-and-wait approach versus surgical resection after chemoradiotherapy for patients with rectal cancer (the OnCoRe project): a propensity-score matched cohort analysis [published online ahead of print December 16, 2015]. Lancet Oncol. doi: 10.1016/S1470-2045(15)00467-2.