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International Watch & Wait Database emphasises importance of endoscopic surveillance

Tue, 06/26/2018 - 12:02
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The first report outcomes form the International Watch & Wait Database (IWWD) has report that local regrowth occurs mostly in the first two years and in the bowel wall, “emphasising the importance of endoscopic surveillance to ensure the option of deferred curative surgery.” The paper, ‘Long-term outcomes of clinical complete responders after neoadjuvant treatment for rectal cancer in the International Watch & Wait Database (IWWD): an international multicentre registry study’, published in The Lancet, was written on behalf of the WWD Consortium.

The authors write that the strategy of watch and wait (W&W) in patients with rectal cancer who achieve a complete clinical response (cCR) after neoadjuvant therapy is new and offers an opportunity for patients to avoid major resection surgery. Nevertheless, the evidence is based on small-to-moderate sized series from specialist centres. Therefore, the International Watch & Wait Database (IWWD) sought to describe the outcome of the W&W strategy in a large-scale registry of pooled individual patient data.

The aim of the IWWD, under the auspices of European Registry of Cancer Care (EURECCA), based in Leiden, the Netherlands, is to inform the public of the developments in the field of organ preservation in rectal cancer management and to promote a network of international health care professionals to foster evidence-based medical information and recommendation dissemination to ensure the maximal spread of ‘core treatment quality standards’ to the appropriate audiences for a maximised benefit of rectal cancer care.

Participating centres entered data in the registry through an online research data server. Data included baseline characteristics, neoadjuvant therapy, imaging protocols, incidence of local regrowth and distant metastasis, and survival status. All patients with rectal cancer in whom the standard of care (total mesorectal excision surgery) was omitted after neoadjuvant therapy were eligible to be included in the IWWD. For the present analysis, the authors only selected patients with no signs of residual tumour at reassessment (a cCR). They analysed the proportion of patients with local regrowth, proportion of patients with distant metastases, five-year overall survival and five-year disease-specific survival.

The paper reports the results from 1,009 patients in the registry who received neoadjuvant treatment and were managed by W&W in the database from 47 participating institutes (15 countries). In total, 880 (87%) patients had a cCR and median follow-up time was 3,3 years. The study authors reported a two-year cumulative incidence of local regrowth of 25.2%, with 88% of all local regrowth diagnosed in the first two years, and 97% of local regrowth was located in the bowel wall. Distant metastasis was diagnosed in 71 (8%) of 880 patients - five-year overall survival was 85% and five-year disease-specific survival was 94%.

This dataset has the largest series of patients with rectal cancer treated with a W&W approach, consisting of approximately 50% data from previous cohort series and 50% unpublished data. Local regrowth occurs mostly in the first 2 years and in the bowel wall, emphasising the importance of endoscopic surveillance to ensure the option of deferred curative surgery. Local unsalvageable disease after W&W was rare.

For more information about the International Watch & Wait Database, please click here