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Low rectal cancer treatment strategies: a cohort study assessing watch and wait

  • Original Article – Clinical Oncology
  • Published:
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Abstract

Purpose

Treatment strategies for low rectal cancer have been evolving toward achieving less treatment morbidity with the same oncological success—we aimed to assess the results of the new watch and wait (W&W) strategy in our cohort.

Methods

A tertiary care cohort study was conducted. New patients with rectal adenocarcinoma up to 6 cm from the anal margin, cM0, locally staged higher than cT1N0, evaluated between November 2014 and October 2018, were included. All 93 patients received neoadjuvant radiotherapy ± chemotherapy. Re-evaluation was planned 8–12 weeks after the end of treatment. Patients showing clinical complete response (cCR) were given the choice of either to proceed to surgery or to enter W&W.

Results

Of the 93 patients, 82.8% were re-evaluated and 20.8% had cCR. Patients in clinical stages II/III were significantly less likely to achieve cCR than those in stage I (p = 0.017).

After a mean follow-up of 17.44 months, there were 4 regrowths in the 16 patients under W&W, all submitted to R0 surgery, ypN0; there were no deaths or local recurrences; one patient with regrowth had distant recurrence.

Sixty patients underwent direct surgery after a mean follow-up of 16.23 months; 3 patients had local and distant recurrences; 7 others had only distant recurrences; there were 8 deaths.

There were no statistically significant differences between patients under W&W and patients who underwent direct surgery regarding local or distant recurrences, or death (p > 0.9; p =  0.44; p =  0.19, respectively).

Conclusion

The W&W strategy for low rectal cancer achieved the same oncological outcomes as the traditional strategy while sparing some patients from surgery.

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Funding

No funding was received for this work.

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Authors and Affiliations

  1. Gastroenterology Department, Instituto Português de Oncologia de Lisboa, Francisco Gentil, EPE, Serviço de Gastrenterologia, Rua Prof. Lima Basto, 1099-023, Lisboa, Portugal

    João Cortez Pinto, António Dias Pereira, Inês Marques & Isadora Rosa

  2. Radiotherapy Department, Instituto Português de Oncologia de Lisboa, Francisco Gentil, EPE, Lisboa, Portugal

    Ana Pimenta, Cátia Pedro, Gonçalo Fernandez, Luísa Mirones & Miguel Labareda

  3. Oncology Department, Instituto Português de Oncologia de Lisboa, Francisco Gentil, EPE, Lisboa, Portugal

    Isália Miguel, João Freire & Teresa Marques

  4. Surgery Department, Instituto Português de Oncologia de Lisboa, Francisco Gentil, EPE, Lisboa, Portugal

    João Maciel, Luís D’Orey, Manuel Limbert & Rita Barroca

  5. Radiology Department, Instituto Português de Oncologia de Lisboa, Francisco Gentil, EPE, Lisboa, Portugal

    José Venâncio

  6. Pathology Department, Instituto Português de Oncologia de Lisboa, Francisco Gentil, EPE, Lisboa, Portugal

    Paula Chaves & Ricardo Fonseca

  7. Nuclear Medicine Department, Instituto Português de Oncologia de Lisboa, Francisco Gentil, EPE, Lisboa, Portugal

    Teresa Ferreira

Authors
  1. João Cortez Pinto
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  2. António Dias Pereira
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  3. Ana Pimenta
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  4. Cátia Pedro
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  5. Gonçalo Fernandez
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  6. Inês Marques
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  7. Isália Miguel
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  8. João Freire
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  9. João Maciel
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  10. José Venâncio
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  11. Luís D’Orey
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  12. Luísa Mirones
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  13. Manuel Limbert
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  14. Miguel Labareda
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  15. Paula Chaves
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  16. Ricardo Fonseca
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  17. Rita Barroca
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  18. Teresa Ferreira
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  19. Teresa Marques
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  20. Isadora Rosa
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Contributions

All authors participated in the conception and design of the study; all authors collected and analyzed data for the study and performed the treatments and/or the diagnostic examinations on the study patients, according to their medical specialty; João Cortez Pinto and Isadora Rosa drafted the article. All authors revised the article critically for important intellectual content and gave approval of the final version to be submitted.

Corresponding author

Correspondence to Isadora Rosa.

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Conflict of interest

Isadora Rosa reports grants, personal fees or non-financial support from ABBVIE, FERRING, MSD, TAKEDA, PHARMAKERN, JANSSEN, and DR FALK PHARMA, outside the submitted work; the remaining authors have nothing to disclose.

Ethics approval

The study was approved by IPOLFG’s Ethics Committee and Investigation Unit (Approval 119/2014) and developed according to the Helsinki Declaration principles.

Consent to participate

All patients gave informed consent for every diagnostic and/or therapeutic procedure/strategy.

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All authors approved the final version of the manuscript for publication.

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Pinto, J.C., Pereira, A.D., Pimenta, A. et al. Low rectal cancer treatment strategies: a cohort study assessing watch and wait. J Cancer Res Clin Oncol 146, 2631–2638 (2020). https://doi.org/10.1007/s00432-020-03248-0

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  • DOI: https://doi.org/10.1007/s00432-020-03248-0

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