ASO Author Reflections: Decision Timing for Organ Preservation in Rectal Cancer After Chemoradiation

Excerpt

The watch-and-wait approach after chemoradiation for rectal cancer has gained interest over the past 10 years.1 One of the main prerequisites for a watch-and-wait approach is an accurate selection of patients with a complete response (CR). Studies have shown that a strict selection strategy leads to a low risk for missing residual tumour but up to 30% of complete responders are “missed” and actually do have a CR after surgery.2 Response evaluation is generally performed 8–10 weeks after CRT, while response appears to be ongoing for at least 14 weeks after CRT.3 Also, the clinical images of a responding tumour tend to lag behind compared to the “true response.” By extending the waiting interval with 6–12 weeks, the number of accurately selected CRs is expected to increase. However, one of the main questions was whether patients who achieve a CR after an extended interval have a similar long-term outcome as patients who already have a CR 6–8 weeks after CRT. …