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Title
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The evaluation of follow‐up strategies of watch‐and‐wait patients with a complete response after neoadjuvant therapy in rectal cancer
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Author
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Institution/Organisation
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Dutch Watch‐and‐Wait Consortium
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Abstract
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| Aim Many of the current follow‐up schedules in a watch‐and‐wait approach include very frequent MRI and endoscopy examinations to ensure early detection of local regrowth (LR). The aim of this study is to analyze the occurrence and detection of LR in a watch‐and‐wait cohort and to suggest a more efficient follow‐up schedule. Method Rectal cancer patients with a clinical complete response (cCR) after neoadjuvant therapy were prospectively and retrospectively included in a multicenter watch‐and‐wait registry between 2004‐2018, with the current follow‐up schedule with 3‐monthly endoscopy and MRI in the first year and 6‐monthly thereafter. A theoretical comparison was constructed for the detection of LR in the current follow‐up schedule against 4 other hypothetical schedules. Results 50/304 (16%) of patients developed a LR. The majority was detected ≤2 years (98%), located in the lumen (94%) and was visible on endoscopy (88%). The theoretical comparison of the different hypothetical schedules suggests that the most optimal follow‐up schedule should focus on the first two years with 3‐monthly endoscopy and 3‐6 monthly MRI. Longer intervals in the first two years will cause delays in diagnosis of LR ranging from 0‐5 months. After two years, increasing the interval from 6 to 12 months did not cause important delays. Conclusion The most optimal follow‐up schedule for a watch‐and‐wait policy in patients with a cCR after chemoradiation for rectal cancer should include frequent endoscopy and to a lesser degree MRI in the first two years. Longer intervals, up to 12 months, can be considered after two years. |
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Language
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English
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Source (journal)
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Colorectal disease. - Oxford
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Publication
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Oxford
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2021
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ISSN
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1462-8910
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DOI
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10.1111/CODI.15636
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Volume/pages
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23
:7
(2021)
, p. 1785-1792
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Article Reference
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codi.15636
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ISI
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000636174900001
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Pubmed ID
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33725387
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Medium
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E-only publicatie
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Full text (Publisher's DOI)
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Full text (open access)
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Full text (publisher's version - intranet only)
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