Wait-and-see policy in clinical complete responders to chemoradiation in rectal cancer: apromising alternative: OP06

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Aim:Neoadjuvant chemoradiation for rectal cancer increasingly results in a complete response. In complete responders a wait-and-see-policy, consisting of omission of surgery and intensive follow-up, could be considered, leading to less morbidity and mortality. The purpose of the study was to determine whether complete responders who follow wait-and-see-policy have comparableprognoses compared to patients with pathological complete response (pCR) after surgery.Method:Complete response (CR) was diagnosed with physical examination, MRI &endoscopy. Patients with CR underwent a wait-and-see-policy. Follow-up consisted of 12-weekly visits and laboratory examinations and 3-6-monthly MRI and endoscopy. The control group with pCR after standard surgery was identified from aprospective cohort-study.Results:Twelve patients followed the wait-and-see-policy (median age 63 [49-78] years). Median follow-up was 21 months (range 2-64). 17 patients (median age 67 [37-82] years) had pCR after surgery, median follow-up was 34 months (range 1-67). In the wait-and-see-patients localrecurrence-free survival, disease-free survival and overall survival were 100%. In the ‘pCR-aftersurgery’-group one patient developed lung metastasis after 3 years. One patient died of pneumonia. Three-year local-recurrence-free survival, was 100%, disease-free survival was 82% and overall survival was 93%.Conclusion:The wait-and-see policy for complete responders after neoadjuvant chemoradiation is apromising and potentially feasible alternative to standard surgical treatment. Identification and followup of complete responders with endoscopy + MRI is feasible.

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