Ask the Doctor: Non-Surgical Approach to Rectal Cancer
Ask the Doctor recently received a pertinent question about new non-surgical approaches in the treatment of Stage II and III rectal cancers. We hope this answer from Dr. Robert Madoff is helpful for others as well.
Question from Edmund:
I have rectal cancer, late Stage 2 or Stage 3. My surgeon says that there is some evidence that if radiotherapy and chemotherapy seem to have been successful, then it may be better not to operate, but he is very reluctant to go this far (that is, he wants to operate).
Do you have any information on a non-surgical approach to Stage 2/3 rectal cancer?
Response from Dr. Robert Madoff:
Dr. Robert Madoff
There is now increasing interest in the “wait and see” approach for Stage II and III rectal cancers that have a clinical complete response to chemoradiation. The approach was pioneered in Brazil by Dr. Angelita Habr-Gama. While reported results are promising, it is not at all currently standard therapy in the United States, and success of this approach is highly dependent upon stringent patient selection, very close follow up, and a very low threshold to intervene with surgery should there be any suspicion of recurrence.
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Chemoradiation has long term side affects that are unknown.
I advocate surgery without radiation or chemotherapy. No doubt that, as a stage 2, I was cured by surgery, and the chemoradiation created so many more complications, and really hurt me more than the surgery itself.
Surgery or poison? I’ll go with surgery.
I write as someone who has undergone the ‘wait and see’ approach. So far it has worked for me, i.e. I had chemotherapy in the Summer. I have since been found to have had a ‘complete clinical response’, i.e. no cancer, so I have not been operated on. Regular checks with be carried out to see if the cancer does recur.
I therefore totally disagree with the post by David McCluskey.
The Journal of Clinical Oncology reports favourable results from other people who have undergone the ‘wait and see’ approach. The cumulative probability for two-year disease-free survival was 89% and 100% for two-year overall survival. The results were achieved with less toxicity and better short-term bowel function in the observed patients compared with those who underwent surgical resection. “Patients with cCR showed a strong preference for the wait-and-see approach over resection primarily because it offered the possibility of avoiding major surgery and a permanent colostomy.”