Seven Years of Watch and Wait With Rectal Cancer-Reflections and Optimisations.
24% of patients treated for rectal cancer achieved complete clinical response, avoiding surgery.
Seven Years of Watch and Wait With Rectal Cancer-Reflections and Optimisations.
Sir Charles Gairdner Hospital (Sir Charles Gairdner Hospital) commenced an observation strategy in patients with a complete clinical response, Watch and Wait (W&W), for rectal adenocarcinoma in 2017 using a rigorous surveillance protocol.
A retrospective review of a prospectively maintained database and medical records was performed.
A total of 142 patients were referred for induction long-course chemoradiotherapy for rectal cancer.
Of the 31 patients in W&W, 5 patients had suspected local regrowth and underwent surgical resection.
Regrowth cases were identified within 9 months by flexible sigmoidoscopy and sometimes on imaging (PET or MRI).
A total of 95 patients did not have cCR and had surgical resection; of these, 20 had CR.
A total of 24% of patients referred for long-course chemoradiotherapy at Sir Charles Gairdner Hospital achieved cCR, and this was sustained in 84%. Sixteen percent of W&W patients had suspected local regrowth.
Our surveillance protocol detected regrowth early, and surgical salvage was always possible.
Twenty percent of patients undergoing surgery having CR despite not having cCR highlights the difficulty of avoiding TME in all patients who have a CR but suggests optimisations of our practice are possible.
We propose a reduction in the length and intensity of our current protocol.