Surgeon perspectives on the use and effects of neoadjuvant chemoradiation in the treatment of rectal cancer: a comprehensive review of the literature

Abstract

The initial benefit of adjuvant therapy in the treatment of rectal cancer patients became evident with prospective studies demonstrating improvements in various oncologic survival outcomes. Due to the improved compliance and reduced toxicity, as well as the potential for tumor down-staging and sphincter preservation, neoadjuvant approaches became the preferred method of administering chemotherapy and radiation. Furthermore, a subgroup of patients has been shown to present with complete clinical response to neoadjuvant therapy. This has resulted in the development of the non-operative "watch and wait" approach, which has initiated discussions on changing the interval from the completion of neoadjuvant therapy to surgical resection. The continued development of the multidisciplinary approach will only further improve our ability to provide patients with the best possible oncologic outcomes.

Wait-and-see treatment strategies for rectal cancer patients with clinical complete response after neoadjuvant chemoradiotherapy: a systematic review and meta-analysis

“…Additionally, although NCRT can help distal rectal cancer patients avoid excision of the anal sphincter, a notable proportion of patients required APR and permanent colostomies. However, even patients who undergo LAR to keep the anal sphincter have high rates of incontinence, anal mucus loss, anal blood loss, and daily pad use [34–36]. A modest but significant proportion of patients who have completed NCRT and have sustained cCR may be able to avoid radical surgery and associated complications if a wait-and-see policy is employed, although some of these patients may still require salvage radical surgery because of LR or DM [37].…”

Use of guideline‐recommended adjuvant therapies and survival outcomes for people with colorectal cancer at tertiary referral hospitals in South Australia

“…For rectal cancers, the optimal interval to surgery with neoadjuvant chemoradiotherapy or adjuvant radiotherapy has not been established, although the Royal Marsden Hospital trial is evaluating results and the French Greccar 6 trial has recently reported on intervals ranging from 6 to 12 weeks . In the Greccar trial, there was a significant increase in the overall morbidity rate in the 11‐week group (as compared with the 7‐week group) due to complications .…”