Watch-and-Wait as a Therapeutic Strategy in Rectal Cancer
File(s)
Published version
Author(s)
Bernier, Laurence
Balyasnikova, Svetlana
Tait, Diana
Brown, Gina
Type
Journal Article
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.
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.
Date Issued
2018-04-01
Date Acceptance
2018-03-01
Citation
CURRENT COLORECTAL CANCER REPORTS, 2018, 14 (2), pp.37-55
ISSN
1556-3790
Publisher
SPRINGER
Start Page
37
End Page
55
Journal / Book Title
CURRENT COLORECTAL CANCER REPORTS
Volume
14
Issue
2
Copyright Statement
© 2018 The Author(s). Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Sponsor
NIHR
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000429451100001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Grant Number
NIHR BRC Royal Marsden
Subjects
Science & Technology
Life Sciences & Biomedicine
Oncology
Watch and wait
Deferral of surgery
Non-operative management
Complete response
Rectal cancer
Organ preservation
PATHOLOGICAL COMPLETE RESPONSE
TOTAL MESORECTAL EXCISION
PHASE-III TRIAL
SHORT-COURSE RADIOTHERAPY
DISEASE-FREE SURVIVAL
NEOADJUVANT CHEMORADIATION THERAPY
ANTERIOR RESECTION SYNDROME
COMPLETE CLINICAL-RESPONSE
X-RAY BRACHYTHERAPY
QUALITY-OF-LIFE
Publication Status
Published
Date Publish Online
2018-03-07