“Watch and wait” strategy after neoadjuvant chemoradiotherapy in rectal cancer: opportunities and challenges

This article discusses both the opportunities and challenges of the “Wait and Watch” approach to rectal cancer patients.

Abstract

The “watch and wait” (W&W) strategy has been widely used in rectal cancer patients who have achieved clinical complete response (cCR) after neoadjuvant chemoradiotherapy (nCRT), which can save them from surgery and improve their quality of life. However, this strategy also has many unsolved practical problems, including the improvement of cCR/pCR rate, the search for efficient predictors, the standard follow-up and the methods of rescue surgery, etc. Larger sample size and more standardized clinical trials are still needed to obtain credible evidence.

Therefore, we must rationally view the cCR after nCRT for middle and low rectal cancer, understand the risk of W&W strategy, and make a reasonable choice. It is particularly important to emphasize that we should actively carry out prospective multi-center clinical trials to produce high-level evidence suitable for Chinese characteristics, so that more rectal cancer patients can benefit from nCRT.