eP351 - “Watch and Wait”: Our Community Cancer Hospital’s Experience with Rectal Cancer’s New Treatment Paradigm

Sunday, June 2, 2024

10:21 AM – 10:26 AM ET, USA

Location: Baltimore Convention Center, Room 318-320

ePoster Presenter(s)

Scott Nguyen, MD

Colon & Rectal Surgery Fellow
OHSU
OHSU
Portland, OR, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

KT

Kelli Tavares, MD

Colon and Rectal Surgeon
William Beaumont Army Medical Center
El Paso, Texas, United States

Disclosure information not submitted.
RP

Rodrigo Pedraza, MD

Colon and Rectal Surgeon
The Oregon Clinic
Portland, Oregon, United States

Disclosure information not submitted.
MK

Maria X. Kiely, MD MPH FACS FASCRS (she/her/hers)

Colon and Rectal Surgeon
The Oregon Clinic
Portland, Oregon, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.
RA

Rehan S. Ahmad, MD, FRCS

Attending Colorectal Surgeon
The Oregon Clinic
Portland, Oregon, United States

Disclosure information not submitted.
DO

David O'Brien, FASCRS, FACS

Colon and Rectal Surgeon
The Oregon Clinic
Portland, Oregon, United States

Disclosure information not submitted.

Senior Author(s)

AH

Amanda V. Hayman, MD, MPH

Colon & Rectal Surgeon
The Oregon Clinic
Portland, Oregon, United States

Disclosure information not submitted.

Author(s)

MW

Mark H. Whiteford, Afilliate Professor of Surgery, OHSU

Director Colorectal Surgery
The Oregon Clinic. Providence Cancer Institute
Portland, Oregon, United States

Disclosure information not submitted.

Purpose/Background: The management of advanced locoregional rectal cancer has drastically changed in recent years following the demonstration of safety of a watch and wait approach after treatment with total neoadjuvant therapy. The aim of our study was to evaluate the outcomes of our experience with the watch and wait strategy for the management of rectal cancer in the setting of a community rectal cancer program.Methods/Interventions: We queried our prospectively maintained “watch and wait” database of all stage II/III rectal cancer patients who underwent total neoadjuvant therapy (either with induction or consolidation chemotherapy approach) with curative intent who did not pursue planned oncologic resection. We tabulated baseline characteristics including demographics and stage as well as response to neoadjuvant therapy metrics (i.e. near complete response (nCR), and complete response (cCR)), and oncologic outcomes (no evidence of disease (NED), locoregional regrowth, distant metastasis, and/or death). Moreover, we evaluated the additional management warranted for persistent or recurrent disease. We used our NAPRC database (first patient enrolled on 12/7/2018) as our denominator to report proportion of complete clinical response. We received IRB approval to maintain the database.Results/Outcomes: We initially had 39 patients collected from 2016-2021. We excluded 5 patients identified at our secondary NAPRC site, as well as one case who has not yet completed treatment, leaving us with 33 patients. Data collection for year 2022 is still pending, but we anticipate an additional 20-25 patients to be included in the final analysis. 41.4% of our patients enrolled in our current watch and wait protocol exhibited cCR after initial treatment with TNT. Of the patients who were deemed to have a nCR after initial assessment following TNT, 58.8% would go on to have a cCR. The mean time to progression to cCR from nCR in these patients was 287 days. 15% of patients required radical resection for progression of disease and there was only 1 patient who developed distant metastasis and subsequent cancer-related mortality.Conclusion/

Discussion: The watch and wait strategy has been successfully implemented in our community rectal cancer program with rates of organ preservation that are similar to those reported in the literature.