PTH-331 Non-operative management of low rectal cancer with complete response to standard neoadjuvant chemoradiotherapy

Abstract

<h3>Introduction</h3> 20% of low rectal cancers respond extremely well to standard long course radiotherapy and on clinical examination apparently disappear from the rectal lumen after chemoradiotherapy; an apparent complete response. There are two dilemmas which follow this: Can we be sure about the complete response and that there is no viable residual tumour tissue? If we believe there is no tumour tissue left, how do we then manage these patients? Our Trust started to suggest non-operative management to ‘complete responders’ in January 2007, and the results were remarkable. <h3>Method</h3> Ongoing study looking at 14 complete responders. Surveillance has been MRI/EUS/EUA under GA during years 0–2 every three months. MRI/EUS/EUA under GA during years 3–5 every six months. MRI/EUS/EUA under GA after 5 years every year. A CT scan and colonoscopy were performed at the two and five year marks. These are the Trust’s local guidelines. <h3>Results</h3> 14 patients in total. Seven are still disease-free and still under surveillance. Three had recurrence; two underwent APR and one underwent ultra low anterior resection; all had R0 resections and are still disease-free. Four were suspected to have recurrence but were not fit for major resections therefore had transanal procedures; all had tumour-free specimens and are still disease-free and under surveillance. <h3>Conclusion</h3> There are an important cohort of patients who have low rectal cancer who may not need an operation. We are still unsure exactly how to manage these patients and it is therefore important for each unit to follow them up and share experiences. As a Trust, we will continue to manage these patients with the diagnosis of low rectal cancer, who are ‘disease-free’ following long course chemoradiotherapy, non-operatively. <h3>Disclosure of interest</h3> None Declared. <h3>References</h3> Smith JD, <i>et al</i>. Non-operative management of rectal cancer with complete response to neoadjvant therapy. Ann Surg. 2012;256:965–972 Habr-Gama A, <i>et al</i>. Non-operative management of distal rectal cancer after chemoradiation: experience with the “watch and wait” policy. Dis. Colon Rectum. 2010;52:1137–1143 Habr-Gama A, <i>et al</i>. Operative versus non-operative treatment for stage 0 distal rectal cancer following chemoradiation therapy. Ann Surg. 2004;240(4):711–718 Tennyson MD, <i>et al</i>. Transanal excision with radiation therapy for rectal cancer. Clin Med Res. 2012;10(4):224–229 Schmoll HJ, <i>et al</i>. ESMO concensus guideline for management of patients with colon and rectal cancer: a personalised approach to clinical decision making. Ann Oncol. 2012;23:2479–2516 Deferral of Surgery (Watch And Wait) Study. Royal Marsden Hospital, Pelican Cancer Foundation, Phase II Multicentre Single-Arm Study, Cancer Research Trial Number CRUK/10/006