Non-operative management in low-lying rectal cancers undergoing chemoradiation

• Published in: Journal of cancer research and therapeutics 2024-01, Vol.20 (1), p.417-422
• Main Authors: Datta, Debanjali, Engineer, Reena, Saklani, Avanish, D'souza, Ashwin, Baheti, Akshay, Kumar, Suman, Krishnatry, Rahul, Ostwal, Vikas, Ramaswamy, Anant, Patil, Prachi
• Format: Article
• Language: English
• Subjects: Adjuvant treatment; Cancer; Care and treatment; Chemoradiotherapy - adverse effects; Chemoradiotherapy - methods; Chemotherapy; Colorectal cancer; Complications and side effects; Diagnosis; Digital Rectal Examination; Humans; Methods; Neoadjuvant Therapy - adverse effects; Neoplasm Recurrence, Local - drug therapy; Patient outcomes; Radiotherapy; Rectal Neoplasms - pathology; Treatment Outcome; Watchful Waiting
• ISSN: 0973-1482; 1998-4138
• DOI: 10.4103/jcrt.jcrt_189_23

To evaluate the outcomes of post-neoadjuvant chemoradiation (NACTRT) wait-and-watch Strategy (WWS) in distal rectal cancers. All consecutive patients from December 2012 to 2019 diagnosed with distal rectal tumors (T2-T4 N0-N+) having a complete or near-complete response (cCR or nCR, respectively) post-NACTRT and wishing for the non-surgical treatment option of WWS were included in this study. Patients were observed with 3 monthly magnetic resonance imaging (MRIs), sigmoidoscopies, and digital rectal examination for 2 years and 6 monthly thereafter. Organ preservation rate (OPR), local regrowth rate (LRR), non-regrowth recurrence-free survival (NR-RFS) and overall survival (OAS) were estimated using the Kaplan-Meier method, and factors associated with LRR were identified on univariate and multivariate analysis using the log-rank test (P < 0.05 significant). Sixty-one consecutive patients post-NACTRT achieving cCR[44 (72%)] and nCR[17 (28%)], respectively, were identified. All patients received pelvic radiotherapy at a dose of 45-50Gy conventional fractionation and concurrent capecitabine. An additional boost dose with either an external beam or brachytherapy was given to 39 patients. At a median follow-up of 39 months, 11 (18%) patients had local regrowth, of which seven were salvaged with surgery and the rest are alive with the disease, as they refused surgery. The overall OPR, NR-RFS, and OS were 83%, 95%, and 98%, respectively. Seven (11%) patients developed distant metastasis, of which six underwent metastatectomy and are alive and well. LRR was higher in patients with nCR versus cCR (P = 0.05). The WWS is a safe non-operative alternative management for selected patients attaining cCR/nCR after NACTRT with excellent outcomes.