Watch-and-Wait in Rectal Cancer: Safe for Patients With Near-Complete Responses?

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For patients with rectal cancer, the option of close clinical surveillance -- i.e., watch-and-wait (WW) -- has long been accepted as an oncologically safe alternative to surgery in those meeting strict criteria for clinical complete response (cCR) to neoadjuvant therapy and total neoadjuvant treatment.

With careful patient selection and close surveillance, the pool of patients eligible for watch-and-wait can be expanded to include those with near-complete response (nCR), said authors of a "Comments and Controversies" article in the Journal of Clinical Oncology.

"When properly applied, WW can safely and effectively manage rectal cancer in nCR patients without compromising oncologic outcomes," noted Julio Garcia-Aguilar, MD, PhD, of Memorial Sloan Kettering Cancer Center in New York City, and colleagues.

They explained that studies have shown that local regrowth rates during the first 2 years of surveillance are higher in patients with nCR managed with WW compared with cCR patients (49% vs 20%, respectively). Patients with regrowth were also more likely to develop distant disease.