Today we had the masterclass, so to say, or an interactive session together with Professor Rodrigo Perez from São Paulo from the Habr-Gama group on watch and wait and the implementation of a watch and wait strategy in rectal cancer treatment.
What were the principal points of this session?
The issue is that first of all when you look to the effect of neoadjuvant chemoradiation in rectal cancer you will find that a subgroup of patients will develop a complete clinical response. So if you give them a radical surgery you don’t find any tumour left. This is really the beginning of another paradigm that you really start now to give neoadjuvant treatment in a so-called curative intent, so to avoid surgery and to put patients in a watch and wait protocol.
But there are some difficulties. First of all it’s how to assess clinical complete response, this is only by digital examination, on top of that endoscopy and now we add on that also imaging like MRI, diffusion MRI and PET scanning. So that’s one of the issues; the second issue is when to do the assessment of the response to neoadjuvant. So progressively you see that the interval became from six to twelve weeks. Normally today we reassess patients at twelve weeks intervals.
A lot of attention went to the selection of patients and whether also patients with nodal or possible nodal disease could also benefit from this approach. Indeed, in most of those patients that get a complete clinical response of the tumour you also see a disappearance of the nodal disease. The background rates of persistent nodal disease is between 5-10%.
Interestingly is then the concept of regrowth. Most of the regrowth occurs within the first year so the first year is of utmost importance. Then the bigger the tumour or the more advanced the tumour was at the initial treatment, the more chances you have on regrowth. Finally, we looked at the possibilities to increase the local control, to increase the dose of radiotherapy, to use the interval to change and give the complete neoadjuvant or the adjuvant chemotherapy in a neoadjuvant setting.
What is the impact of this congress?
It’s always a must for people who are involved in GI cancer treatment. You get really an update year to year; you get again the theoretical aspect, you see where the innovation is going on. It’s very important.
