P-0283 - Wait & See policy following Complete Clinical Response to Chemoradiotherapy in Rectal Cancer, Single Centre Experience

Date 28 June 2014
Event World GI 2014
Session Poster Session
Topics Anti-Cancer Agents & Biologic Therapy
Rectal Cancer
Surgery and/or Radiotherapy of Cancer
Presenter Muhammad Latif
Citation Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165
Authors M. Latif1, N. Day2, A. Montazeri1
  • 1Clatterbridge Cancer Centre, Wirral/UK
  • 2Wirral University Teaching Hospital NHS trust, Wirral/UK

Abstract

Introduction

Neoadjuvant chemoradiotherapy (CRT) is the standard treatment for locally advanced rectal cancers with threatened or involved circumferential resection margins (CRM). CRT can result in a complete clinical response (cCR) in 15 to 20% of cases which means a Wait & See policy can be considered instead of surgery in this group of patients. The aim of this study was to evaluate the outcome of our Wait & See policy for rectal cancer patients demonstrating a cCR to neoadjuvant CRT and compare this with published data.

Methods

A retrospective review was performed using clinical case notes, electronic patient records, pre and post treatment diagnostic imaging records for patients treated in a single clinic at Clatterbridge Cancer Centre between July 2010 to March 2013.

Results

A total of 10 patients with cCR were identified in our Wait & See group. The median age at diagnosis was 64 (51-66) years. 9 (90%) patients were male and 1 (10%) female. Adenocarcinoma was reported in all 10 patients. Distance from the anal verge was 0-5 cm in 6 (60%) patients, 5.1 to 10 cm in 1 (10%) patient and >10cm in 3 (30%) patients. Pre treatment magnetic resonance imaging (MRI) scan reported threatened CRM in all 10 patients. T2 was the commonest stage in 8 (80%) patients while 2 (20%) patients had T3 disease. All 10 patients received Radiotherapy at a dose of 45 gray in 25 fractions over 5 weeks with concurrent capecitabine chemotherapy in 9 patients. 1 patient received concurrent 5 fluorouracil. 2 patients received adjuvant chemotherapy with capecitabine. All 10 patients were reviewed in follow up clinics with 3 monthly follow up MRI rectal staging protocols that included diffusion weighting. Computed tomography scan of the chest, abdomen and pelvis was performed annually as part of our local protocol. Median duration of follow up was 16 months (1.4 to 34.9). All patients are alive with no evidence of local or distant relapse.

Conclusion

Our experience has shown no local or distal recurrence in the Wait & See group which is comparable to the published data. Wait & See policy can be considered in a selected group of patients demonstrating a cCR following neoadjuvant CRT in rectal cancer. Prospective randomised studies with a large patient population are needed to further evaluate this approach.