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Non-surgical “Watch and Wait” Approach to Rectal Cancer

  • Radiation Therapy and Radiation Therapy Innovations in Colorectal Cancer (P Lee and A Raldow, Section Editors)
  • Published:
Current Colorectal Cancer Reports

Abstract

Purpose of Review

The standard of care for locally advanced rectal cancer is preoperative chemoradiation (CRT) followed by total mesorectal excision (TME). Patients who achieve a pathologic complete response (pCR) to CRT have favorable oncologic outcomes. Given the significant morbidity and long-term effects on quality of life associated with radical resection, the role of surgery in the subgroup of patients with a clinical complete response (cCR), of whom a significant proportion may have a pCR, is under debate.

Recent Findings

An emerging tailored approach to treatment is a “watch and wait” strategy in patients who have a cCR after CRT with the goal of organ preservation. However, concordance between a cCR and pCR is not highly reliable, and improved multimodality prediction algorithms are needed to better predict which patients have achieved a pCR and can therefore safely undergo a “watch and wait” approach.

Summary

We review the current data on non-operative management of rectal cancer and ongoing controversies associated with this approach.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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  1. Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place-Box 1128, New York, NY, 10029-6574, USA

    Zahra Ghiassi-Nejad & Karyn Goodman

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Correspondence to Zahra Ghiassi-Nejad.

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Zahra Ghiassi-Nejad declares no potential conflicts of interest.

Karyn Goodman is on the Advisory Board of RenovoRx.

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Ghiassi-Nejad, Z., Goodman, K. Non-surgical “Watch and Wait” Approach to Rectal Cancer. Curr Colorectal Cancer Rep 16, 118–124 (2020). https://doi.org/10.1007/s11888-020-00460-5

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