Rectal Cancer Watch & Wait Management: Experience of 545 Patients from the U.S. Rectal Cancer Research Group
Samuel H. Lai, Maria Widmar, John R.T. Monson, Fergal J. Fleming, Arden M. Morris, Jon D. Vogel,BACKGROUND:
The use of a watch and wait management strategy following a complete clinical response to neoadjuvant therapy for rectal cancer is increasing. However, insights into implementation, treatments, and outcomes, on a United States national level, are limited.
OBJECTIVE:
To investigate and report on watch & wait management practices and outcomes in the US.
DESIGN:
Retrospective study.
SETTING:
Multicenter.
PATIENTS:
Stage II or III rectal cancer patients who underwent intentional watch & wait management between January 2015 and August 2022.
MAIN OUTCOME MEASURES:
Patient and tumor characteristics, neoadjuvant treatment and response, local cancer regrowth and metastasis, salvage surgery, overall and disease-specific survival.
RESULTS:
Among 545 patients from 33 centers, follow-up was 21 months (range, 9-37). Total neoadjuvant therapy or other types of neoadjuvant were used in 395 (72%) and 150 (28%) of patients, respectively. Estimated 3-year local regrowth rate was 23.8% (95% CI: 19.1-29.4%). Patients with local regrowth had higher distant metastases incidence (14.2% vs. 3.5%,
LIMITATIONS:
Retrospective study.
CONCLUSION:
This multicenter study indicates that the watch & wait approach for locally advanced rectal cancer is feasible with acceptable outcomes across a variety of geographical regions and practice settings in the US. Local regrowth and distant metastasis rates were within published norms and salvage surgery proved effective. See Video Abstract.