Wait-and-see policy in patients with rectal cancer treated with chemoradiotherapy

The purpose of this study was to evaluate the safety and utility of a wait and see policy in patients with rectal cancer treated with chemoradiotherapy. 

Treatment options for patients with rectal cancer (cancer in the final part of the large bowel) is chemotherapy with or without radiotherapy (together called chemoradiotherapy or CRT) to shrink the cancer and kill cancer cells that may have spread to the lymph nodes. Usually, CRT is followed by surgery to remove the cancer. However, up to 20% of the patients who receive CRT for rectal cancer have no remaining cancer left after surgery, when a pathologist examines the tissue removed. This is called a pathological complete response. Therefore, an intensive follow-up of patients with complete response after CRT could be as effective as surgery.

This study was conducted between 2004 and 2010 on 21 patients with rectal cancer who had a complete clinical response (defined as no evidence of cancer on imaging methods) after CRT. Patients were followed up every 3 to 6 months for 2 years. The follow-up protocol consisted in digital rectal examination and imaging methods such as endoscopy (a test in which a small tube with a camera attached is inserted into the rectum to examine the inner lining of the bowel), MRI (magnetic resonance imaging, which uses magnetic waves to make pictures of the body) and computed tomography scans (a type of x-ray scan for bones and soft tissues). The results were compared with the ones from a group of 20 patients who had no cancer cells present after CRT and surgery. Only one patient from the wait and see group developed a local cancer recurrence (return of the cancer) after 22 months and he received surgery. The other 20 patients are alive and disease-free.

In summary, a wait and see policy in patients with rectal cancer treated with CRT avoided surgery in most of the patients and was safe in this selected group of patients.

A possible limitation of the study could be the small size of the group. Also the follow up time was short and late recurrences can occur. Future studies should consider a larger population of patients who can be followed up for a longer period of time to confirm these findings.