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WAIT-AND-SEE STRATEGY IN LOW RECTAL CANCER
Isadora Rosa*1, João Cortez-Pinto1, Rodrigo Oom1, Catarina Travancinha1, Gonçalo Fernandez1, Inês Marques1, Isália Miguel1, Joao Freire1, João Pereira da Silva1, José Venâncio1, Luís d'Orey1, Luísa Mirones1, Manuel Limbert1, Paula Chaves1, Ricardo Fonseca1,2, Rita Barroca1, Teresa Ferreira1, Teresa Marques1, António Dias Pereira1
1IPOLFG, EPE, Lisbon, Portugal; 2FMUL, Lisbon, Portugal
Introduction
The standard treatment for locally advanced low rectal adenocarcinoma (ADC) is to conduct surgical resection after neoadjuvant chemoradiotherapy (CRT). In the wait-and-see (W&S) strategy, those who achieve clinical complete response (cCR) after CRT undergo regular clinical, radiologic and endoscopic surveillance, with surgery being reserved for tumor "regrowth".
Objectives
To evaluate the impact of a W&S strategy for low rectal ADC, regarding overall and disease-free survival.
Methods
Single-center prospective observational study. All patients with low rectal (up to 6cm from the anal verge) ADC, stage I to III, discussed in a multidisciplinary colorectal cancer clinic since the implementation of the W&S strategy (11/2014-11/2016) were evaluated.
Demographic data, post-CRT evaluation and decision, recurrence rates, "regrowth" and mortality were analyzed.
Results
56 patients were evaluated [(54% males; mean age at diagnosis 64,4 years (34-90)], of which 53 had already completed CRT. Stage III prevailed (79%) in the initial evaluation.
From the 53 patients who completed CRT, 77% were clinically reevaluated and submitted to pelvic MRI and sigmoidoscopy, after a mean of 6.7 weeks. 17% (7/41) displayed cCR and entered W&S surveillance program. In this subgroup, with a maximum follow-up of 25 months, there was only one (14%) "regrowth", which was clinically detected and then confirmed by the other surveillance methods. This patient underwent a R0 low anterior resection and there were no complications. There were no distant recurrences or deaths. In the subgroup of patients with no Ccr: pathologic complete response was observed in 20%; there was one lymphatic recurrence; the overall survival was 95,2%.
Conclusion
Preliminary results of our series confirm that the W&S strategy is associated with overall and disease-free survival not inferior to those of the traditional approach, favoring its implementation.
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