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Neoadjuvant chemoradiotherapy followed by total mesorectal excision is the standard of care for locally advanced rectal cancer. The mean pathological complete response rate following neoadjuvant chemoradiotherapy has been reported to be 12% to 16%. In clinical complete responders after neoadjuvant chemoradiation, a non-operative, watch-and-wait approach is thus proposed to allow for organ preservation. This paper reviews key studies of the watch-and-wait approach following neoadjuvant chemoradiotherapy for rectal cancer to determine its oncological outcomes and safety.

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Conclusion: When controlling for patient and tumor characteristics, those undergoing both Y90 and TACE showed improved survival. Y90 alone showed no difference in survival when compared to TACE alone. This latter group had the poorest overall survival. While broader utilization of TACE with Y90 might be indicated, prospective studies are needed.