Unintended consequences of treating early rectal cancers for complete clinical response with chemoradiotherapy

The aim was to examine the current trend in rectal cancer, which is to extend ’watch-and-wait’ to earlier-stage tumors, not normally treated with chemoradiotherapy, to define the up-side and down-side regarding quality of life (QOL) and anorectal/sexual/urinary function from this approach. We review...

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Bibliographic Details
Published in:Colorectal cancer 2020-03, Vol.9 (1)
Main Authors: Glynne-Jones, Rob, Bhuva, Neel, Harrison, Mark
Format: Article
Language:English
Subjects:
brachytherapy
Cancer therapies
chemoradiation
Chemotherapy
Colorectal cancer
complete clinical response
Decision making
dose-response
external beam radiotherapy
Medical prognosis
Mutation
nonoperative treatment ‘watch and wait’ organ sparing
Ostomy
preoperative
Radiation therapy
rectal cancer
Tumors
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Summary:The aim was to examine the current trend in rectal cancer, which is to extend ’watch-and-wait’ to earlier-stage tumors, not normally treated with chemoradiotherapy, to define the up-side and down-side regarding quality of life (QOL) and anorectal/sexual/urinary function from this approach. We reviewed the literature regarding a ‘watch-and-wait’ strategy after neoadjuvant chemoradiotherapy. The primary outcome measure was complete clinical response. Secondary measures included colostomy rate, functional outcomes and QOL. There is a trend to use chemoradiotherapy in earlier tumors using dose-escalation of radiation and/or additional chemotherapy, resulting in high rates of complete clinical response, which may impact adversely on QOL if radical surgery is subsequently required. Focusing on organ-preservation as the primary goal of treatment rather than overall functional outcomes and QOL for the whole population, may not provide patients with sufficient information for optimal decision-making.
ISSN:1758-194X
1758-1958
DOI:10.2217/crc-2019-0010