The Proper Treatment for the Complete Responder After Neoadjuvant Therapy

  • Angelita Habr-Gama
  • Maria Susana Bruzzi
  • Maria Laura Morici
  • Guilherme Pagin São Julião
  • Rodrigo Oliva Perez
Chapter

Abstract

The incorporation of new treatment modalities has significantly increased the complexity of decision-making for patients with locally advanced rectal cancer. Neoadjuvant chemoradiation (CRT) is considered one of the preferred treatment strategies for these patients. In addition, this treatment strategy may lead to significant tumor regression, ultimately leading to complete pathological response in up to 42% of patients. The assessment of tumor response following CRT and prior to radical surgery may identify patients with complete clinical response that could be managed nonoperatively with strict follow-up (watch and wait strategy) and thus avoiding unnecessary postoperative morbidity, including long-term urinary, sexual, and fecal continence dysfunctions and the frequent need for temporary or definitive stomas.

Avoiding immediate surgery for patients with complete clinical response may provide good long-term oncological outcomes and excellent functional results. In addition, close surveillance may allow early detection of local recurrences with salvage options avoiding any oncological compromise. This chapter deals with critical issues in appropriate selection of patients, details in follow-up, and management of local recurrences following a nonoperative approach to a patient with complete clinical response following neoadjuvant CRT.

Keywords

Rectal cancer Neoadjuvant chemoradiation therapy Complete clinical response Watch and wait 

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Copyright information

© Springer Japan 2018

Authors and Affiliations

  • Angelita Habr-Gama
    • 1
    • 2
  • Maria Susana Bruzzi
    • 1
  • Maria Laura Morici
    • 1
  • Guilherme Pagin São Julião
    • 1
  • Rodrigo Oliva Perez
    • 1
    • 3
  1. 1.Angelita & Joaquim Gama InstituteSão PauloBrazil
  2. 2.University of São Paulo School of MedicineSão PauloBrazil
  3. 3.Colorectal Surgery Division, Department of GastroenterologyUniversity of São Paulo School of MedicineSão PauloBrazil

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