Patients with rectal cancer who undergo first-line chemotherapy and radiation have lower risk of recurrence and higher rates of survival regardless of whether they choose to have surgery, according to a study published in The Lancet Gastroenterology & Hepatology (published online May 4, 2017: doi:10.1016/S2468-1253(17)30074-2).
Standard of care for patients with rectal cancer that has spread only to nearby tissues or lymph nodes is chemoradiation, followed by surgery. However, surgery can result in clinical complications, a permanent colostomy, and overall poor quality of life. A surveillance approach — termed “watch-and-wait” — can be administered to patients with clinical complete response to neoadjuvant chemoradiation in order to avoid conventional surgery. Data regarding the safety of this approach is limited.
Fahima Dossa, MSc, surgical resident, St Michael’s Hospital, University of Toronto (Canada), and colleagues conducted a systematic review and meta-analysis of 23 studies involving the watch-and-wait approach to rectal cancer. A total of 867 patients’ data were analyzed in the review. Researchers assessed non-regrowth recurrence, cancer-specific mortality, disease-free survival, and overall survival by comparing patients who underwent the watch-and-wait approach with those who underwent conventional surgery.
Researchers found recurrence in only 15.7% of all patients after first-line therapy. Additionally, researchers reported that almost all patients who had a recurrence could be effectively treated with surgery or radiation at the time the recurrence was detected.
No significant difference was reported between patients managed with watch-and-wait and patients with clinical response treated with surgery in terms of non-regrowth recurrence, cancer-specific mortality, disease-free survival, or overall survival.
"The fact that patients in these studies chose to avoid surgery despite not knowing the safety of this approach is a reminder of the various factors that go into cancer treatment decisions," said one of the authors in a press release (May 4, 2017). "At the very least, we are hopeful that this study will open the door to discussions between select patients and their surgeons about the option of a watch-and-wait approach.
The evidence to support the watch-and-wait approach may be challenging the current standard of care for rectal cancer, the authors note. Further research involving prospective studies are needed to confirm long-term safety of the approach. — Zachary Bessette