ASCRS 2020 Scientific Meeting Banner
Complete Response after Neoadjuvant Therapy for Rectal Cancer: Cases and Considerations

CME Credit Hours: 1.5

Current treatment for mid- and low rectal cancer involves a multidisciplinary approach aimed at reducing local failure rates in the pelvis and potentially improving survival. For years, the standard sequence has been neo-adjuvant chemotherapy and radiation therapy followed by surgery, whether a low anterior resection or an abdominal perineal resection, followed by a course of adjuvant chemotherapy. However, many studies have shown that up to 25% of patients treated with neo-adjuvant chemotherapy and radiation therapy have a pathology report that shows no residual tumor. Given that neo-adjuvant treatments produce a complete response in a significant number of patients and given that the operations offered for these mid- and low lying rectal cancers can have a dramatic effect of a patient’s quality of life, there is growing enthusiasm for trying to clinically identify patients who have had a complete response, and sparing them a major operation. Sphincter preservation has changed, potentially, to organ preservation, but there is still much to learn before not operating on patients who are judged to have had a complete response to their neo-adjuvant therapies becomes the new paradigm. Colorectal surgeons would like to offer resection to those who need resection and safely not operate on those who predictably have no tumor left in the pelvis.

Objectives

At the conclusion of this session, participants should be able to:

  1. Recognize what a complete response clinically and radiographically
  2. Understand what patients should be treated and how they should be treated when a complete response is the goal of therapy
  3. Appreciate what a reasonable watch and wait strategy looks like and the consequence of tumor regrowth

Director

Kirk Ludwig, MD, Milwaukee, WI


Introduction
Kirk Ludwig, MD, Milwaukee, WI

Case #1 The Patient is So Young: Is This Dangerous?
Who Should Be Considered for a Watch-and-Wait Approach?
Erin Kennedy, MD, PhD, Toronto, ON, Canada

Case #2 Looks Good, But Does Not Feel Perfect.
How Can MR Imaging Help in Assessment of Tumor Response?
Regina Beets-Tan, MD, PhD, Amsterdam, Netherlands

Case #3 We Are So Close to a Complete Response. Can We Get There?
How to Get to a Complete Response and Can We Get From a Near-Complete Response to a Complete Response? CH/RT, TNT, More RT or Change Who We Treat?
Julio Garcia-Aguilar, MD, PhD, New York, NY

Case #4 The Tumor Looks Like It Has Regrown. Now What?
Reasonable Plans for Watch-and-Wait and What If There is Tumor Regrowth?
Matthew Kalady, MD, Columbus, OH

Panel Discussion and Audience Questions

Adjourn