Omitting surgery and using a watch-and-wait approach does not compromise outcomes for selected patients with advanced rectal cancer in clinical complete response after chemotherapy and radiotherapy, according to a study being presented at the 2017 Gastrointestinal Cancers Symposium.1
“Some people with rectal cancer undergo surgery after chemoradiation therapy, even though it may not be necessary,” Maxime van der Valk, MD, a coordinator of the International Watch and Wait Database (IWWD) Consortium and Leiden University Medical Center in Leiden, Netherlands, said in a press release. “From the data we have now, it seems that watch-and-wait may be safe in selected patients with rectal cancer, but it is too soon to say whether this approach should be routinely offered.”
Although treatment for rectal cancer varies widely across and within countries, surgery is typically included in disease management. Patients with stage 2 to 4 rectal cancer usually receive neoadjuvant chemotherapy and/or radiotherapy prior to surgery, and about 20% of patients achieve a complete response before surgery. It may therefore be necessary to re-stage patient disease prior to surgery and to compare the risks and benefits of performing surgery or a watch-and-wait approach.
Researchers analyzed data from 802 patients without signs of residual disease following chemoradiotherapy. All patients received watch-and-wait care, which included intensive monitoring for cancer recurrence instead of surgery.
During follow-up (median 2.6 years), a quarter of patients underwent delayed surgery due to cancer regrowth; 7% developed distant metastasis. The 3-year survival rate was 91% among all patients, and 87% among those who had local disease recurrence. These findings were consistent with historical data from patients who underwent surgery.
“Despite seeing excellent outcomes in our study, we know the decision to undergo surgery is personal for every patient,” said Dr. van der Valk. “When faced with the risk of permanent colostomy, some patients will prefer to avoid surgery, while others won’t want to deal with the uncertainty of their cancer recurring.”
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Further collection and analysis of prospective and retrospective data on watch-and-wait strategies in rectal cancer are still needed to inform international guidelines on treatment and surveillance of patients with rectal cancer.
- Van Der Valk M. The International Watch & Wait database (IWWD) for rectal cancer: An update. J Clin Oncol. 2017;35(suppl):4S. Abstract 521.