Waiting room.

Surgery-free management of rectal cancer has been making headway in recent years. While still awaiting prospective data, Wash U is here to lend us their experience with watchful waiting following short course radiation followed by consolidative chemo. Impressively, half of patients undergoing this total neoadjuvant therapy approach for stage I-III disease from 2018-2019 achieved a complete clinical response (cCR, n=43). Compared with those who didn’t achieve this, those with a cCR had significantly more of all the characteristics you would guess: less advanced stage, smaller primary tumor, and no baseline involvement of the circumferential resection margin. Also as expected, they had better local and distant control as well as disease-free and overall survival, again presumably due to better baseline characteristics. Perhaps most interesting is that 30 of 38 patients (79%) undergoing watchful waiting remained free from recurrence at a median follow-up of 30 months, with 8 of 8 successfully surgically salvaged upon recurrence. | Chin, Int J Radiat Oncol Biol Phys 2021

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