Patients with Rectal Cancer May Not Need Intense Surveillance After Three Years with No Evidence of Disease

Using a watch and wait strategy, patients with rectal cancer who sustain a clinical complete response – meaning they are found to have no evidence of disease – for three years may not need intense surveillance after that point, according to data published in Lancet Oncology.

“Our results suggest that achieving a complete clinical recovery and sustaining it for one year is the most relevant protective factor in patients with rectal cancer, placing them in an excellent prognosis,” says Laurie Fernandez, lead researcher, in a press release.

The watch and wait strategy is used in patients with rectal cancer who have a clinical complete response after neoadjuvant chemoradiotherapy. These patients are usually put under a close and intensive watch because regrowth occurs in 25% of patients, with metastases occurring in 10% of patients, but there is a debate over how long this follow-up should continue for.

With this study, researchers sought to determine an appropriate follow-up length for these patients using the International Watch & Wait Database, an archive of patients with clinical response after neoadjuvant chemotherapy whose status is currently being managed with a watch and wait approach.

Using this database, researchers identified 793 patients across 15 countries with rectal cancer who had a clinically complete response after neoadjuvant chemotherapy and were following a watch and wait approach from Nov. 25, 1991 to Dec. 31,2015.

At a median follow up of 55.2 months, in patients who had sustained a clinically complete response, researchers found the probability of remaining free from a regrowth to be 88.1% at one year, 97.3% at three years, and 98.6% at five years.

“Once patients have achieved and sustained a complete clinical response [recovery] for one year, known risk factors (such as the stage of the disease before any treatment and the dose of radiation received by the patient) seem to become irrelevant”, said lead author Laura M. Fernandez in a press release on the study.

Additionally, the probability of remaining free of distant metastasis was at 93.8% one year, 97.8% at three years and 96.6% at five years.

According to the press release, these results suggests that those with rectal cancer could possibly replace aggressive colorectal surgery with radio chemotherapy followed by close surveillance for a few years. Although risk factors play a major role in regrowth, these results suggest that they may not be as important the longer a patient maintains a clinical complete response, the researchers noted.

“For patients who survived the first year without recurrence, the risks for local regrowth and distant metastases during the two subsequent years were considerably lower,” Fernandez concluded, “making it unnecessary to maintain such an intense surveillance after three years.”

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