Watch and wait policy after preoperative radiotherapy for rectal cancer; management of residual lesions that appear clinically benign.
BACKGROUND
During an ongoing phase II observational study on watch and wait policy in rectal cancer, a substantial number of patients presented residual lesion after radiotherapy with a clinical benign appearance. This article aims to discuss the clinical significance of such findings.


METHODS
Main entry criteria were age ≥70 years and small tumour (≤5 cm and ≤60% of circumferential involvement) located in the low rectum. Patients received chemoradiation (50 Gy, 2 Gy per fraction concomitantly with a 5-Fu bolus and leucovorin) or 5 × 5 Gy if considered unfit for chemotherapy. Patients with clinical complete response (cCR) were observed. Those with persistent tumours underwent transanal endoscopic microsurgery [TEM] if the baseline tumour was ≤3 cm and cN0 or total mesorectal excision.


RESULTS
The watch and wait procedure was used in 11 out of the total 35 patients (31%) with a cCR; 17 patients (49%) with residual tumours that appeared clinically malignant were referred for TEM or abdominal surgery. In the remaining seven (20%), the residual tumour clinically appeared benign. Of these, there were two invasive cancers, four high-grade dysplasias and one low-grade dysplasia. The five patients with dysplasia, underwent local lesion resection without recurrence within a median of 11 months follow-up.


CONCLUSIONS
The majority of lesions that appeared clinically benign after radio(chemo)therapy were also benign on pathological examination. Thus, local excision of such lesions should be considered.
Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland; Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Centre, Warsaw, Poland.
M
M
Rupinski
Department of Rehabilitation, Jozef Piłsudski University of Physical Education, Poland; Clinical Department of General and Colorectal Surgery, Bielanski Hospital Warsaw, Poland.
M
M
Szczepkowski
Department of Pathology, Maria Sklodowska-Curie Memorial Cancer Centre, Warsaw, Poland.
M
M
Malinowska
Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland; Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Centre, Warsaw, Poland.
A
A
Mroz
Department of Radiotherapy II, M. Sklodowska-Curie Memorial Cancer Centre, Warsaw, Poland.
L
L
Pietrzak
Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Centre, Warsaw, Poland.
L
L
Wyrwicz
Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Centre, Warsaw, Poland.
A
A
Rutkowski
Department of Radiotherapy II, M. Sklodowska-Curie Memorial Cancer Centre, Warsaw, Poland. Electronic address: bujko@coi.waw.pl.
K
K
Bujko
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D059248:Chemoradiotherapy; D019583:Dose Fractionation, Radiation; D005472:Fluorouracil / Q000008:administration & dosage; D002955:Leucovorin / Q000008:administration & dosage; D018365:Neoplasm, Residual; D059351:Organ Sparing Treatments; D012004:Rectal Neoplasms / Q000473:pathology / Q000628:therapy; D000067369:Transanal Endoscopic Microsurgery; D047368:Tumor Burden; D057832:Watchful Waiting
D005472:Fluorouracil; D002955:Leucovorin
Organ preservation; Preoperative radiotherapy; Rectal cancer