Wait-and-See Policy Feasible for Some With Rectal Cancer

Using strict selection criteria and follow-up, wait-and-see results in promising outcomes

WEDNESDAY, Nov. 9 (HealthDay News) -- For patients who have complete clinical response (cCR) following chemoradiotherapy for rectal cancer, a wait-and-see-policy is feasible and promising if strict selection criteria and follow-up are implemented, according to a study published online Nov. 7 in the Journal of Clinical Oncology.

Monique Maas, M.D., from the Maastricht University Medical Center in the Netherlands, and colleagues evaluated the feasibility and safety of a wait-and-see policy in 21 patients with rectal cancer with a cCR selected prospectively using magnetic resonance imaging (MRI) and endoscopy plus biopsies. MRI, endoscopy, and computed tomography scans were performed every three to six months during a mean follow-up of 25 ± 19 months. A group of 20 control patients with a pathologic complete response (pCR) after surgery were followed for a mean of 35 ± 23 months. The Memorial Sloan-Kettering Cancer Center bowel function questionnaire and Wexner incontinence score were used to measure functional outcome, and Kaplan-Meier curves were used to estimate long-term outcome.

The investigators found that one patient with cCR in the wait-and-see group developed a local recurrence which necessitated surgery as a salvage treatment. The remaining 20 patients were alive without disease. Among the patients with pCR, the cumulative probabilities were 93 and 91 percent for two-year disease-free survival and overall survival, respectively.

"A wait-and-see policy with strict selection criteria, up-to-date imaging techniques, and follow-up is feasible and results in promising outcome at least as good as that of patients with a pCR after surgery," the authors write.

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