“Surgery for rectal cancer is highly effective, but the risks, recovery period, and long-term impact on function have a significant effect on quality of life for patients,” said ASCO Expert Nancy Baxter, MD, FRCSC, FACS, PhD, moderator of today’s presscast. “It’s essential that we pursue further research in this area to better understand which patients with rectal cancer can be safely treated with a watch-and-wait approach.”
ALEXANDRIA, Va. – Real-world data from a large observational study suggests that omitting surgery in strictly selected patients with a clinical complete response does not compromise outcomes. The three-year survival rate among patients who received “watch-and-wait” care after initial cancer treatment was 91%, which is similar to historic survival rates for patients who undergo surgery. This is welcome news, as rectal surgery carries the risk of debilitating complications, such as colostomy and urinary and sexual problems. The study will be presented at the upcoming 2017 Gastrointestinal Cancers Symposium in San Francisco.
Rectal cancer treatment strategies vary widely across and within countries, but surgery is a standard part of care. In most countries, patients with stage II-IV rectal cancer receive chemotherapy and/or radiation before surgery. Although in about 20% of patients the tumor completely disappears after pre-surgery therapy, it is not standard to re-assess or “restage” the tumor to see if surgery is still needed.
“Some people with rectal cancer undergo surgery after chemoradiation therapy, even though it may not be necessary,” said Maxime van der Valk, MD, one of the study-coordinators of the International Watch and Wait Database Consortium and Leiden University Medical Center in Leiden, Netherlands. “From the data we have now, it seems that watch-and-wait may be safe in selected patients with rectal cancer, but it is too soon to say whether this approach should be routinely offered.”
Study data were collected through the International Watch and Wait Database Consortium (IWWD), which includes 35 institutions in 11 countries. According to the authors, this represents the largest series of patients with rectal cancer for whom surgery was omitted after chemotherapy and radiation therapy.
The analysis included 802 patients who had no signs of residual cancer after induction treatment, based on physical exam, endoscopy, or scans (MRI or CT) following chemotherapy and radiation. The patients all received watch-and-wait care, which included intensive monitoring for cancer recurrence. In the first two years, patients visited the hospital every three months for endoscopy, MRI scans, and physical exams.
Watch-and-wait is not yet a standard of care for patients with rectal cancer in any country (it is estimated that it is used in fewer than 5% of all patients). There is no universal watch-and-wait strategy for patients with rectal cancer yet. Worldwide, there are significant variations in pre-surgery treatments and approaches used to determine if a tumor shows regression or disappears after chemoradiation and methods of monitoring for cancer recurrence.
After a median follow-up of 2.6 years, 25% of patients underwent delayed surgery because a regrowth of the cancer was diagnosed, and distant metastases occurred in 7% of patients. The three-year survival rate was 91% among all patients, and 87% among those who experienced local cancer recurrence. This is consistent with historic data from patients who undergo surgery.
“Despite seeing excellent outcomes in our study, we know the decision to undergo surgery is personal for every patient. When faced with the risk of permanent colostomy, some patients will prefer to avoid surgery, while others won’t want to deal with the uncertainty of their cancer potentially recurring,” said Dr. van der Valk.
The IWWD Consortium aims to collect all available prospective and retrospective data on watch-and-wait strategies in rectal cancer. Further data collection and analysis may inform international guidelines on treatment and surveillance for patients with rectal cancer.
This study was supported by grants from EURECCA (European Registration of Cancer Care, an ESSO initiative) and the Champalimaud foundation in Lisbon.
View the full abstract.
For your readers:
2017 Gastrointestinal Cancers Symposium News Planning Team
Nancy Baxter, MD, FRCSC, FACS, PhD, American Society of Clinical Oncology (ASCO); Laura Dawson, MD, American Society for Radiation Oncology (ASTRO); and Kenneth Cardona, MD, FACS, Society of Surgical Oncology (SSO).
Click here to view the disclosures for the News Planning Team.
ATTRIBUTION TO THE 2017 GASTROINTESTINAL CANCERS SYMPOSIUM IS REQUESTED IN ALL NEWS COVERAGE.
About the American Gastroenterological Association Institute:
The American Gastroenterological Association (AGA) is the trusted voice of the GI community. Founded in 1897, the AGA has grown to include more than 16,000 members from around the globe who are involved in all aspects of the science, practice and advancement of gastroenterology. The AGA, a 501(c6) organization, administers all membership and public policy activities, while the AGA Institute, a 501(c3) organization, runs the organization's practice, research and educational programs. On a monthly basis, the AGA Institute publishes two highly respected journals, Gastroenterology and Clinical Gastroenterology and Hepatology, and has recently launched a third journal, Cellular and Molecular Gastroenterology and Hepatology. The organization's annual meeting is Digestive Disease Week®, which is held each May and is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy, and gastrointestinal surgery. The AGA Research Foundation provides digestive disease research grants on behalf of the AGA Institute.
For more information and to join, visit gastro.org/membership.
About the American Society for Radiation Oncology:
The American Society for Radiation Oncology (ASTRO) is the premier radiation oncology society in the world, with more than 10,000 members who are physicians, nurses, biologist, physicists, radiation therapists, dosimetrists and other health care professionals that specialize in treating patients with radiation therapies. As the leading organization in radiation oncology, the Society is dedicated to improving patient care through professional education and training, support for clinical practice and health policy standards, advancement of science and research, and advocacy. ASTRO publishes three medical journals, International Journal of Radiation Oncology, Biology, Physics, Practical Radiation Oncology, and Advances in Radiation Oncology, developed and maintains an extensive patient website; and created the Radiation Oncology Institute, a non-profit foundation to support research and education efforts around the world that enhance and confirm the critical role of radiation therapy in improving cancer treatment. Learn more about ASTRO.
Founded in 1964, the American Society of Clinical Oncology, Inc. (ASCO®) is committed to making a world of difference in cancer care. As the world’s leading organization of its kind, ASCO represents more than 40,000 oncology professionals who care for people living with cancer. Through research, education, and promotion of the highest-quality patient care, ASCO works to conquer cancer and create a world where cancer is prevented or cured, and every survivor is healthy. ASCO is supported by its affiliate organization, the Conquer Cancer Foundation. Learn more at www.ASCO.org, explore patient education resources at www.Cancer.Net, and follow us on Facebook, Twitter, LinkedIn, and YouTube.
About the Society of Surgical Oncology:
The Society of Surgical Oncology (SSO) is the premier organization for surgeons and health care providers dedicated to advancing and promoting the science and treatment of cancer. The Society’s focus on all solid-tumor disease sites is reflected in its Annual Cancer Symposium, monthly scientific journal (Annals of Surgical Oncology), educational initiatives, and committee structure. The Society’s mission is to improve multidisciplinary patient care by advancing the science, education, and practice of cancer surgery worldwide. SSO’s 2016-2017 President is Daniel G. Coit, MD, Professor of Surgery with Weill Cornell Medical College and surgical oncologist with Memorial Sloan Kettering Cancer Center. For more information, visit surgonc.org or SSO2016.org.