Nonoperative management safe, feasible after complete response in rectal cancer

Patients with locally advanced rectal cancer who achieve complete response (CR) following sequential short-course radiation therapy (SCRT) and chemotherapy appear to benefit from nonoperative management (NOM) with a watch-and-wait strategy, which presents evidence for good anorectal functions, results of a study have shown.

A team of investigators conducted a retrospective study of patients treated with SCRT and chemotherapy who achieved a CR and were managed with NOM. They assessed bowel function using the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30, EORTC Quality of Life Questionnaire-Colorectal Cancer 29, and the low anterior resection syndrome (LARS) questionnaires.

Study endpoints were as follows: overall survival (OS), freedom from local failure (FFLF), freedom from distant metastasis, and disease-free survival (DFS).

Of the 26 patients who met the eligibility criteria, seven (26.9 percent) developed local failure at a median of 6.8 months following CR, but five were successfully salvaged.

Median FFLF was not reached, with rates of 100.0 percent at 6 months, 82.3 percent at 1 year, and 71.3 percent at 2 years. Median OS was also not reached, with rates of 100.0 percent at 6 months, 1 year, and 2 years. Likewise, median DFS was not reached, with rates of 100.0 percent, 95.0 percent, and 89.4 percent at 6 months, 1 year, and 2 years, respectively.

Majority of the participants (83.3 percent) responded to the questionnaire. Median LARS score was 27. Major, minor, and no LARS occurred in three (20 percent), six (40 percent), and six (40 percent) patients, respectively.

“There were no differences in questionnaire scores between patients who had the majority of their anal sphincter complex irradiated and those who did not,” the investigators said.