P-0273 - Still awaiting that waiting be a validated affordable option in rectal cancer? Our Watch and Wait approach experience in Co-Recto
|Date||28 June 2014|
|Event||World GI 2014|
|Topics|| Rectal Cancer
|Citation||Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165|
S. Iseas1, G. Mendez1, A. Aguilo1, M. Barugel1, E. Roca1, M. Carballido1, M. Coraglio1, F. Leiro2, A. Dieguez3, M. Eleta4
Controversies exist about the proper management of the patients with clinical complete tumor regression after preoperative combined modality therapy. A non-operative management of selected patients has achieved promising long-term outcomes in some Watch and Wait (W&W) single series. Regardless of encouraging results, and in spite of being a readily accepted strategy by patients, reluctance to recommend this strategy as an affordable option still exists in rectal cancer guidelines. Our aim is to evaluate the outcome of the omission of surgery with a close follow up for patients with clinical complete response discussed in Co-Recto (interdisciplinary and cooperative team for the Management of rectal cancer), Argentina.
Patients with resectable non metastatic rectal cancer (stage I-III) who were selected for neoadjuvant therapy in Co-Recto between 2008-2013 were retrospectively reviewed in order to determine our series of patients with clinical complete response(cCR) selected for Non operative management. Clinical complete response was defined by co- assessment between digital exam, strict endoscopic criteria, MRI and CEA. The follow-up for patients candidates for Watch and Wait policy was performed during the first two years with MRI and endoscopy three-monthly and computed tomography scans six-monthly. Median follow-up was calculated in months after completion of CRT.
Twenty nine pts with cCR were included in our series of W&W policy. The Initial staging was performed by MR (27/29, 93%) and EUS (6/29, 20%). Based on main risk factors: 18% (5/29) were T2-T3ab N0; 41% (12/29 were T3c/d-T4, N+ and 41% (12/29) had CRM+. The median distance from anal verge was 30mm. Involvement into/beyond the elevator muscle was informed in 36%(10/29). CRT consisted of long-course RT (50.4 Gy) with concurrent capecitabine (825 mg/m2 twice daily for 7 days/week). Induction chemotherapy (CAPOX) was administered in 36% followed by CRT. The median interval for response assessment was 7 weeks (5-12w). Adjuvant therapy was administered in 18% cases. Local recurrence was observed in 2/29pts (7%) within the rectal wall. One developed am nodal recurrence without endoluminal recurrence and other patient had endoluminal component. Both feasible of salvage resection. Median interval to recurrence was 24 months. Distant metastases and extrarectal pelvic recurrence wereńt observed in any case. After a mean follow up of 28 months (7-53m), no deaths occurred.
A nonoperative management with a close follow up based on strict criteria was a feasible approach, had an optimal outcome and avoided usual surgical functional sequelae in our series. So far, several single experiences were reported with promising results. Definitively in order to mitigate the remaining skepticism, all these data should lead to a commitment for collaborative randomized trials.