Surgery: unnecessary for patients with rectal cancer?13 Jan 2015
A retrospective review of clinical data collected between 2006 and 2014 included 145 patients with stage 1-3 rectal cancer whose tumors completely disappeared after treatment with chemoradiation and systemic chemotherapy, divided into two groups:
- those that had immediate surgery, and
- those who pursued a "watch and wait" surveilance approach.
The review showed that these two groups had similar 4-year survival rates.
The “watch and wait” approach, as an alternative to immediate rectal surgery
“We believe that our results will encourage more doctors to consider this “watch and wait” approach as an alternative to immediate rectal surgery, at least for some patients,” said senior study author Philip Paty, MD, a surgical oncologist at the Memorial Sloan-Kettering Cancer Center in New York, USA, adding that in about 40-50% patients with stage 1 rectal cancer and 30-40% patients with stage 2-3 cancer, tumors disappear clinically after initial treatment with chemoradiation and systemic chemotherapy, suggesting that those patients are potential candidates for the ”watch and wait” approach.
Similar survival rate in no-surgery and surgery group
From the 73 of 145 patients of the study who deferred rectal surgery after complete tumor regression due to radiation and chemotherapy, only 26% eventually underwent rectal surgery to treat tumor regrowth whereas 74% experienced durable tumor regression and avoided rectal surgery.
For the 72 remaining patients who underwent standard rectal surgery from the beginning, researchers found, in a non-randomized comparison, that the outcomes were similar to the outcomes of patients who deferred surgery; the 4-year overall survival rate was 91% in the no-surgery group vs. 95% in the standard surgery group.
Added benefits of non-surgical management
Non-surgical management of rectal cancer is becoming increasingly accepted as a standard option worldwide. By avoiding rectal surgery, patients are spared of its risks, including impaired bowel and sexual function, which can substantially diminish quality of life. In a prospective phase 2 study, non-surgical management will be offered to selected patients to show that with frequent follow-up exams after initial chemotherapy and radiation, patients with rectal cancer can achieve excellent outcomes while avoiding the risks and complications of rectal surgery.
Source: eCancer News