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Background <p>Watch-and-wait (W&amp;W) is an organ-preserving strategy for rectal cancer patients achieving clinical complete or near-complete response after neoadjuvant chemoradiotherapy (nCRT). Long-term data from low- and middle-income settings remain limited.</p> Methods <p>We conducted a retrospective analysis of a prospectively maintained single-center cohort (2007–2024) managed with W&amp;W following nCRT, with structured surveillance. Endpoints included local regrowth/recurrence, salvage treatment, progression-free survival (PFS), and overall survival (OS).</p> Results <p>Ninety-eight patients were included. Estimated 5-year OS exceeded 85% and organ preservation exceeded 75%. Local regrowth/recurrence occurred in 19.4%, predominantly within 24 months; salvage surgery was feasible in the majority of localized regrowths. Response assessment by MRI tumor regression grade (mrTRG) was available in 76 patients. A total of 26.5% (<i>n</i> = 26) were lost to follow-up, which may influence long-term outcome estimates.</p> Conclusion <p>In carefully selected patients, W&amp;W after nCRT demonstrated favorable survival and organ preservation in this Indian cohort. Interpretation should remain cautious due to attrition, evolving treatment-era practices, and lack of a comparative surgical control arm.</p>

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Wait-and-Watch Strategy Following Neoadjuvant Chemoradiotherapy for Rectal Cancer: a Prospective Cohort Study from an Indian Tertiary Care Center

  • 期刊论文

  • 发表日期：

    2026年4月24日

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  • Ayyappan,
  • Bhargavi Ilangovan,
  • S. G. Raman,
  • Vikas Mahajan,
  • Jegan K. Niwas,
  • Janarthinakani,
  • Kapil,
  • Ezhil,
  • Varshini Selvaraj,
  • Sreenidhi

摘要

Background

Watch-and-wait (W&W) is an organ-preserving strategy for rectal cancer patients achieving clinical complete or near-complete response after neoadjuvant chemoradiotherapy (nCRT). Long-term data from low- and middle-income settings remain limited.

Methods

We conducted a retrospective analysis of a prospectively maintained single-center cohort (2007–2024) managed with W&W following nCRT, with structured surveillance. Endpoints included local regrowth/recurrence, salvage treatment, progression-free survival (PFS), and overall survival (OS).

Results

Ninety-eight patients were included. Estimated 5-year OS exceeded 85% and organ preservation exceeded 75%. Local regrowth/recurrence occurred in 19.4%, predominantly within 24 months; salvage surgery was feasible in the majority of localized regrowths. Response assessment by MRI tumor regression grade (mrTRG) was available in 76 patients. A total of 26.5% (n = 26) were lost to follow-up, which may influence long-term outcome estimates.

Conclusion

In carefully selected patients, W&W after nCRT demonstrated favorable survival and organ preservation in this Indian cohort. Interpretation should remain cautious due to attrition, evolving treatment-era practices, and lack of a comparative surgical control arm.