Organ Preservation in Rectal Cancer: The Patients' Perspective

Abstract

Organ preservation after a clinical complete response to radiochemotherapy is currently one of the most discussed topics in the management of rectal cancer. However, the patients' perspective has only been poorly studied so far. In this multicenter study, we examined 49 patients with locally advanced rectal cancer. The willingness to participate in an organ preservation study and the acceptance of the associated aspects such as intensified radiochemotherapy protocols, the need for close follow-up examinations and local regrowth rates were assessed. Attitudes were correlated with baseline quality of life parameters and psychological scales for “fear of progression”, “locus of control”, “depression”, and the “willingness to take risks”. A total of 83% of patients would consider the deferral of surgery in case of a clinical complete response (cCR). Three monthly follow-up studies and a 25% local regrowth rate are considered acceptable by 95% and 94% respectively. While 41% would be willing to exchange cure rates for a non-operative treatment strategy, a potentially more toxic radiochemotherapy in order to increase the probability of a cCR was the aspect with the lowest acceptance (55%). Psychological factors, in particular “locus of control” and “willingness to take risks”, influenced patient preferences regarding most of the assessed parameters. While in general a broad acceptance of an organ-preserving treatment can be expected, patient preferences and concerns regarding different aspects of this strategy vary widely and require specific consideration during shared decision making.

Durvalumab (MEDI 4736) in combination with extended neoadjuvant regimens in rectal cancer: a study protocol of a randomised phase II trial (PRIME-RT)

“…The number of trials investigating novel strategies to improve responses to neoadjuvant treatment and to increase organ preservation rates that reported findings in 2020 [ 8 , 12 , 40 , 41 ] demonstrates the intense interest in this approach within the academic and clinical community. A recent survey of patients with rectal cancer in Germany has confirmed that treatment intensification to improve organ preservation rates is also a concept favoured by patients, even at the expense of toxicity from multi-modality non-surgical treatment [ 42 ].…”

Neoadjuvant Chemoradiation Combined with Regional Hyperthermia in Locally Advanced or Recurrent Rectal Cancer

“…These results are of highest clinical relevance. In the context of organ preservation strategies, the development of radiotherapy protocols that increase clinical complete response rates with limited toxicity and thus quality more patients for a “watch and wait” approach, are in the focus of research [ 26 ]. According to the standards of the time when the trial was initiated, surgery was scheduled four to six weeks after the end of radiotherapy.…”

Metformin with neoadjuvant chemoradiation to improve pathologic response in rectal cancer: A pilot phase I/II trial

“…In studies on neoadjuvant treatment for rectal cancer, it is expected some patients with a cCR will be reluctant to undergo surgery. Indeed, cCR patients at our institution are typically offered the option of non-operative management and close surveillance [26] . We thus reported a combined pCR/cCR rate and considered this value appropriate for future trial design.…”