Current Status of the Watch-and-Wait Policy for Patients with Complete Clinical Response Following Neoadjuvant Chemoradiation in Rectal Cancer

Preoperative chemoradiation is the standard of care for patients with locally advanced rectal cancer to reduce the risk of local recurrence. Chemoradiation can achieve a pathological complete response (pCR) in 10–20% of patients when surgery is performed at 4–12 weeks following completion, and a clinical complete response (cCR) in 15–30% if surgery is withheld. The probability of pCR and cCR is partly dependent on initial clinical T- and N-stage. Observational/retrospective studies suggest a selective watch-and-wait policy with rigorous surveillance, avoiding radical surgery, is a safe option to offer patients who achieve a cCR or near cCR. With a watch-and-wait approach, approximately one third will relapse within 12 months, but regrowth is almost invariably endoluminal, and can often be salvaged without compromising overall survival. The aim of this overview is to examine the current status of the watch-and-wait policy for patients with cCR following chemoradiation in rectal cancer.