The Approach to the Rectal Cancer Patient with a Suspected Complete Clinical Response: Selection of Patients to the Watch and Wait Strategy

2013 ◽  
pp. 251-258
Author(s):  
Rodrigo O. Perez ◽  
Angelita Habr-Gama
Keyword(s):  
Rectal Cancer ◽  
Cancer Patient ◽  
Clinical Response ◽  
Response Selection ◽  
Rectal Cancer Patient ◽  
Complete Clinical Response ◽  
Watch And Wait ◽  
Selection Of Patients ◽  
Selection Of

scholarly journals Cost Effectiveness of Watch and Wait Versus Resection in Rectal Cancer Patients with Complete Clinical Response to Neoadjuvant Chemoradiation

2021 ◽  
Author(s):  
Christina Liu Cui ◽  
William Yu Luo ◽  
Bard Clifford Cosman ◽  
Samuel Eisenstein ◽  
Daniel Simpson ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Cost Effectiveness ◽  
Clinical Response ◽  
Disease Progression ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiation ◽  
Complete Clinical Response ◽  
Watch And Wait ◽  
Recurrence Rates ◽  
Life Years

Abstract Background Watch and wait (WW) protocols have gained increasing popularity for patients diagnosed with locally advanced rectal cancer and presumed complete clinical response after neoadjuvant chemoradiation. While studies have demonstrated comparable survival and recurrence rates between WW and radical surgery, the decision to undergo surgery has significant effects on patient quality of life. We sought to conduct a cost-effectiveness analysis comparing WW with abdominoperineal resection (APR) and low anterior resection (LAR) among patients with stage II/III rectal cancer. Methods In this comparative-effectiveness study, we built Markov microsimulation models to simulate disease progression, death, costs, and quality-adjusted life-years (QALYs) for WW or APR/LAR. We assessed cost effectiveness using the incremental cost-effectiveness ratio (ICER), with ICERs under $100,000/QALY considered cost effective. Probabilities of disease progression, death, and health utilities were extracted from published, peer-reviewed literature. We assessed costs from the payer perspective. Results WW dominated both LAR and APR at a willingness to pay (WTP) threshold of $100,000. Our model was most sensitive to rates of distant recurrence and regrowth after WW. Probabilistic sensitivity analysis demonstrated that WW was the dominant strategy over both APR and LAR over 100% of iterations across a range of WTP thresholds from $0–250,000. Conclusions Our study suggests WW could reduce overall costs and increase effectiveness compared with either LAR or APR. Additional clinical research is needed to confirm the clinical efficacy and cost effectiveness of WW compared with surgery in rectal cancer.

scholarly journals Case Report of a Clinically Complete Response in a Rectal Cancer Patient after Chemoradiotherapy with a 2-year Watch and Wait Approach

2017 ◽  
Vol 42 (5) ◽  
pp. 835-840
Author(s):  
Matsuda Keiji ◽  
Ohno Kohei ◽  
Okada Yuka ◽  
Yagi Takahiro ◽  
Tsukamoto Mitsuo ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Case Report ◽  
Cancer Patient ◽  
Rectal Cancer Patient ◽  
Complete Response ◽  
Watch And Wait

scholarly journals Management of the Complete Clinical Response

2017 ◽  
Vol 30 (05) ◽  
pp. 387-394 ◽  
Author(s):  
Guilherme São Julião ◽  
Bruna Vailati ◽  
Ivana Castro ◽  
Debora Raffaele ◽  
Angelita Habr-Gama
Keyword(s):  
Rectal Cancer ◽  
Clinical Response ◽  
Radical Surgery ◽  
Local Relapse ◽  
Neoadjuvant Chemoradiation ◽  
Complete Clinical Response ◽  
Watch And Wait ◽  
Long Term Outcomes

AbstractOrgan preservation is considered in the management of selected patients with rectal cancer. Complete clinical response observed after neoadjuvant chemoradiation for rectal cancer is one of these cases. Patients who present complete clinical response are candidates to the watch-and-wait approach, when radical surgery is not immediately performed and is offered only to patients in the event of a local relapse. These patients are included in a strict follow-up, and up of 70% of them will never be operated during the follow-up. This strategy is associated with similar oncological outcomes as patients operated on, and the advantage of avoiding the morbidity associated to the radical operation. In this article we will discuss in detail the best candidates for this approach, the protocol itself, and the long-term outcomes.

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