Take a load off Fanny.
The Study: You may recall total neoadjuvant therapy (TNT) for rectal cancer, a popular idea that touts improved outcomes plus the potential for some patients to avoid surgery altogether. While the data on that approach continues to grow, the massive International Watch and Wait Database (IWWD) is adding an interesting new twist. This Dutch database includes >1K patients who did not undergo immediate surgery after neoadjuvant therapy, 90% of whom had a clinical complete response (CR). Patients without a CR or who were unfit for surgery were excluded. About half had T3 disease, and some form of endoscopic and/or MRI reassessment was performed after treatment in the majority of cases. The rate of tumor regrowth at 2 years was 25%, with only 5% of patients experiencing a nodal recurrence. Importantly, roughly two-thirds of recurrences happned in the first year. Overall survival rate at 5 years was 85%—88% for those with no regrowth and 75% for those with regrowth. Of note, strictly speaking, the vast majority of patients in this database received neoadjuvant chemoradiation rather than TNT that would involve more intensive chemotherapy.
Bottom Line: Among patients who defer surgery after neoadjuvant therapy for rectal cancer, survival is favorable and the rate of regrowth is 25% (mostly within the first year). | van der Valk, Lancet 2018