Study examines 'watch-and-wait' approach for people with rectal cancer

May 4, 2017, St. Michael's Hospital

A study published today suggests that a select group of patients with rectal cancer who undergo chemotherapy and radiation may have low rates of recurrence and good survival rates regardless of whether they go on to have surgery.

The conventional treatment for people with of the rectum - the final part of the , ending at the anus - that has spread to nearby tissues or but not to other organs is chemoradiation to shrink the tumour, followed by . But the surgery can result in complications, a permanent colostomy and poor quality of life.

Some patients have such a dramatic response to chemotherapy and radiation that there is no detectable tumour at the time of surgery, said Dr. Fahima Dossa, the study's lead author and a surgical resident at St. Michael's Hospital. These patients, termed complete responders, have excellent survival and low rates of , which raises questions about whether they benefit from surgery, said Dr. Dossa.

Since 2004, some surgeons have offered these patients the option of surgery or a "watch-and-wait" approach that involves close followup. However, the safety of that approach remains unclear.

In a paper published online today in The Lancet Gastroenterology & Hepatology, Dr. Dossa and her team conducted a systematic review and meta-analysis of 23 studies involving 867 patients who adopted the "watch-and-wait" approach. Cancer returned in the rectum of only 15.7 per cent of these patients.

"What is striking is not only the low rate of cancer , but also that almost all the patients who had a recurrence could still be treated with surgery or radiation at the time the recurrence was detected," said Dr. Dossa.

Only three patients with a recurrence could not undergo further treatment—either surgery or more radiation - due to the extent of the renewed cancer. The analysis did not find differences in mortality between those who took the watch-and-wait approach and those who underwent surgery.

Dr. Nancy Baxter, the study's senior author and chief of general surgery at St. Michael's, said that while many of the studies were small, the evidence to support a "watch-and-wait" approach is growing, challenging the current standards of care for .

"The fact that patients in these studies chose to avoid surgery despite not knowing the safety of this approach is a reminder of the various factors that go into cancer treatment decisions," said Dr. Baxter. "At the very least, we are hopeful that this study will open the door to discussions between select and their surgeons about the option of a watch-and-wait approach.

Explore further: New method reduces adverse effects of rectal cancer treatment

Related Stories

New method reduces adverse effects of rectal cancer treatment

February 10, 2017
A new study from Karolinska Institutet shows that short-course preoperative radiotherapy combined with delayed surgery reduces the adverse side-effects of rectal cancer surgery without compromising its efficacy. The results ...

Study: radiation an important addition to treatment for pancreatic cancer surgery candidates

January 18, 2016
Radiation therapy was associated with a lower risk of cancer recurrence in pancreatic cancer surgery patients, making it, like chemotherapy, an important addition to treatment, Mayo Clinic research found.

Review examines rates and predictors of recurrence following surgery for Crohn's disease

December 8, 2016
Some patients with Crohn's disease, a chronic inflammatory disease that affects the lining of the digestive tract, require surgery to remove part or all of the large intestine; however, surgery does not cure the condition ...

Skipping surgery may work for some rectal cancer patients: study

January 13, 2015
(HealthDay)—For many rectal cancer patients, the prospect of surgery is a worrisome reality, given that the operation can significantly impair both bowel and sexual function.

Radiation an important addition to treatment for pancreatic cancer surgery candidates

January 5, 2016
Radiation therapy was associated with a lower risk of cancer recurrence in pancreatic cancer surgery patients, making it, like chemotherapy, an important addition to treatment, Mayo Clinic research found. Whether radiotherapy ...

Breast cancer prognosis of African-American patients may improve with chemotherapy before surgery

January 19, 2017
Administering chemotherapy to African-American breast cancer patients prior to surgery could improve their prognosis and survival rates from the disease, according to a new study.

Recommended for you

Researchers find adult stem cell characteristics in aggressive cancers from different tissues

September 19, 2018
UCLA researchers have discovered genetic similarities between the adult stem cells responsible for maintaining and repairing epithelial tissues—which line all of the organs and cavities inside the body—and the cells that ...

Colon cancer is caused by bacteria and cell stress

September 19, 2018
Researchers at Technical University Munich have reported findings related to the development of colon cancer. "We originally wanted to study the role of bacteria in the intestines in the development of intestinal inflammation," ...

Eating foods with low nutritional quality ratings linked to cancer risk in large European cohort

September 18, 2018
The consumption of foods with higher scores on the British Food Standards Agency nutrient profiling system (FSAm-NPS), reflecting a lower nutritional quality, is associated with an increased risk of developing cancer, according ...

CRISPR screen reveals new targets in more than half of all squamous cell carcinomas

September 18, 2018
A little p63 goes a long way in embryonic development—and flaws in p63 can result in birth defects like cleft palette, fused fingers or even missing limbs. But once this early work is done, p63 goes silent, sitting quietly ...

Could the zika virus fight the brain cancer that killed john McCain?

September 18, 2018
(HealthDay)—Preliminary research in mice suggests that the Zika virus might be turned from foe into friend—enlisted to curb deadly glioblastoma brain tumors.

Enlarged genotype-phenotype correlation for a three-base pair deletion in neurofibromatosis type 1

September 18, 2018
International collaborative research led by Ludwine Messiaen, Ph.D., shows that while a three-base pair, in-frame deletion called p.Met992del in the NF1 gene has a mild phenotype for people with the genetic disorder neurofibromatosis ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.