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Curr Colorectal Cancer Rep. 2018;14(2):37-55. doi: 10.1007/s11888-018-0398-5. Epub 2018 Mar 7.

Watch-and-Wait as a Therapeutic Strategy in Rectal Cancer.

Author information

1
1CHU de Québec - Hôtel-Dieu de Québec, 11 côte du Palais, Québec, QC G1R 2J6 Canada.
2
2The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT UK.
3
3Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT UK.
4
4Gastrointestinal Cancer Imaging, Department of Radiology, The Royal Marsden NHS Foundation Trust NIHR BRC and Imperial College London, Downs Road, Sutton, Surrey, SM2 5PT UK.

Abstract

Purpose of Review:

Pathological complete response is seen in approximately one fifth of rectal cancer patients following neoadjuvant chemoradiation. Since these patients have excellent oncological outcomes, there has been a rapidly growing interest in organ preservation for those who develop a clinical complete response. We review the watch-and-wait strategy and focus on all aspects of this hot topic, including who should be considered for this approach, how should we identify treatment response and what are the expected outcomes.

Recent Findings:

The major challenges in interpreting the data on watch-and-wait are the significant heterogeneity of patients selected for this approach and of methods employed to identify them. The evidence available comes mostly from retrospective cohort studies, but has shown good oncological outcomes, including the rate of successful salvage surgery, locoregional control and overall survival.

Summary:

There is currently not enough and not robust enough evidence to support watch-and-wait as a standard approach, outside a clinical trial, for patients achieving clinical complete response following neoadjuvant chemoradiation. Furthermore, there is a lack of data on long-term outcomes. However, the results we have so far are promising, and there is therefore an urgent need for randomised control studies such as the TRIGGER trial to confirm the safety of this strategy.

KEYWORDS:

Complete response; Deferral of surgery; Non-operative management; Organ preservation; Rectal cancer; Watch and wait

Conflict of interest statement

Compliance with Ethical StandardsThe authors declare that they have no conflict of interest.This article does not contain any studies with human or animal subjects performed by any of the authors.

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