Diagnosis and treatment strategy for clinical complete responders after chemoradiotherapy for rectal cancer: is watch-and-wait policy safe?

Abstract

Neo-adjuvant chemoradiotherapy (NACRT) combined with total mesorectal excision (TME) surgery is the main treatment for locally advanced middle-low rectal cancer, and NACRT significantly improves the local control rate of rectal cancer. According to the current guidelines, patients who receive clinical complete response (cCR) after NACRT are recommended for treatment with TME surgery. A few studies have shown that the watch-and-wait (WAW) policy is safe and could ensure anorectal function and quality of life in patients with cCR. In addition, such patients must be closely observed and followed up so as to enable salvage surgery for long periods of tumor re-growth. However, there is not enough evidence to provide a clear answer to the oncological effect of the WAW policy. As a result, WAW policy is not widely available in clinical practice, and further prospective studies are needed to assess its risk and benefit for the patients.