Top Line: Watch and wait (W&W) is an option for patients with rectal cancer who have complete response to neoadjuvant therapy, but how often is this approach taken in the real world?
The Study: This study used the NCDB to analyze trends in organ preservation (or W&W) for rectal cancer between 2006 and 2020. It included 175,545 patients with stage I (17.4%, II (24.7%), or III (32.1%) rectal cancer (25.7% had unknown stage). From 2006 to 2020, the rate of organ preservation increased from 18.4% to 28.2%. This was mainly driven by increased organ preservation rates among those with stage II (18→31.8%) and stage III (15.3→28.8%) disease. Among those with stage I disease, the rate of organ preservation actually declined as did the rate of transanal excision. A qualitative look at practice patterns for stage II-III disease showed a peak in the use of neoadjuvant RT followed by surgery and adjuvant chemo in the 2010’s with declines in neoadjuvant RT alone and surgery followed by adjuvant therapy. However, the late 2010’s saw a rise in the use of multiagent chemotherapy and radiation followed by either surgery or observation. Such changes likely contributed to another observation that pathologic complete response rates rose significantly from 6.5% in 2006 to 18.8% in 2020.
TBL: Since 2006, there has been a significant increase in the utilization of neoadjuvant multiagent chemotherapy and radiation for rectal cancer and a 10% absolute increase in rates of organ preservation. | Loria, JAMA Oncol 2023
The Study: This study used the NCDB to analyze trends in organ preservation (or W&W) for rectal cancer between 2006 and 2020. It included 175,545 patients with stage I (17.4%, II (24.7%), or III (32.1%) rectal cancer (25.7% had unknown stage). From 2006 to 2020, the rate of organ preservation increased from 18.4% to 28.2%. This was mainly driven by increased organ preservation rates among those with stage II (18→31.8%) and stage III (15.3→28.8%) disease. Among those with stage I disease, the rate of organ preservation actually declined as did the rate of transanal excision. A qualitative look at practice patterns for stage II-III disease showed a peak in the use of neoadjuvant RT followed by surgery and adjuvant chemo in the 2010’s with declines in neoadjuvant RT alone and surgery followed by adjuvant therapy. However, the late 2010’s saw a rise in the use of multiagent chemotherapy and radiation followed by either surgery or observation. Such changes likely contributed to another observation that pathologic complete response rates rose significantly from 6.5% in 2006 to 18.8% in 2020.
TBL: Since 2006, there has been a significant increase in the utilization of neoadjuvant multiagent chemotherapy and radiation for rectal cancer and a 10% absolute increase in rates of organ preservation. | Loria, JAMA Oncol 2023