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Balasuriya, Hasitha D.; Timon, Charles; Entriken, Fiona; Neely, David; Herron, John; Tang, Colin; Van Hazel, Guy; Warner, Michael W.

Early results from implementation of a ‘watch and wait’ protocol for complete clinical response following chemoradiotherapy for rectal cancer

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  • Media type: E-Article
  • Title: Early results from implementation of a ‘watch and wait’ protocol for complete clinical response following chemoradiotherapy for rectal cancer
  • Contributor: Balasuriya, Hasitha D.; Timon, Charles; Entriken, Fiona; Neely, David; Herron, John; Tang, Colin; Van Hazel, Guy; Warner, Michael W.
  • imprint: Wiley, 2022
  • Published in: ANZ Journal of Surgery
  • Language: English
  • DOI: 10.1111/ans.17915
  • ISSN: 1445-1433; 1445-2197
  • Origination:
  • Footnote:
  • Description: <jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Neoadjuvant long course chemoradiotherapy (NLCRT) for rectal cancer can result in complete pathological response (pCR). In 2017, we started offering patients who had a complete clinical response (cCR), a choice between total mesorectal excision (TME) and an intensive surveillance or ‘watch and wait’ (W&amp;W) program. We report the early outcomes of this prospective study.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>All patients undergoing NLCRT from 2017 to 2019 were included. All patients were restaged at 8 weeks, and those who had a cCR were offered TME or W&amp;W.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Of 59 patients who underwent NLCRT, 55 had restaging. Eleven of these patients had a cCR (20%). Three chose to have TME and all had a pCR. Eight were enrolled in W&amp;W. Two patients were diagnosed with local regrowth and underwent TME at 7 and 17 months after NLCRT.</jats:p><jats:p>A further nine patients, who were surgically unfit or refused TME, and had an excellent response to NLCRT, but one that did not reach criteria for a cCR, were also managed with W&amp;W. Of these, two patients developed regrowth with distant metastases.</jats:p><jats:p>From 2017 to 2019, of the 17 patients who were managed with a W&amp;W approach, 13 patients have remained regrowth free after a median of 28 (13–58) months of W&amp;W.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Preliminary findings suggest management with W&amp;W, following cCR, may be a safe alternative to TME. There have so far been no instances of distant failure, and those with cCR that had regrowth, were identified early and successfully managed with salvage TME.</jats:p></jats:sec>