Watch & Wait approach following total neoadjuvant therapy of rectal cancer: a case report

Modern standardized treatment of locally advanced rectal cancer (LARC) consists of preoperative chemoradiotherapy (CTRT), operative resection with total mesorectal excision (TME), followed by postoperative chemotherapy (CT) in selected patients. With escalated intensity of preoperative treatment, there was a significant increase in pathological (pCR) and clinical complete responses (cCR). In carefully selected patients with cCR, close monitoring - watch & wait approach (W&W) instead of surgical treatment is possible. Survival of only monitored patients is not worse in comparison with operated patients, but with the addition of avoiding surgical treatment-related mortality and postoperative complications. In Slovenia, the W&W approach is included in the latest national recommendations for the treatment of colon and rectal cancer. Despite the many benefits of the W&W approach, a risk of recurrence and distant metastasizing still remains. Careful selection of patients is crucial for a favourable treatment outcome. The main problem is cCR assessment subjectivity. This paper describes the case of a patient with LARC who was treated with preoperative CTRT after cCR. The patient was treated with a W&W approach. Two years after beginning treatment, the disease had progressed, and the patient later died.