Is Non-surgical treatment with watch & wait possible for locally advanced rectal cancer?

Presented in 13th World Gastroenterology, IBD & Hepatology Conference in Holiday Inn Dubai, Al Barsha, UAE & Virtual from December 15-17, 2023. 

Speaker Name: Prof Arthur Sun Myint – Professor of University of Liverpool (United Kingdom)
Category: (Oral  / Poster presentation / Workshop)

Biography: Prof. Sun Myint graduated from IM (2) Yangon, Burma in 1972. He was appointed as a Clinical scientist for the Medical Research Council’s Neutron trial project in 1983 and chaired the colorectal sub-group for neutron trials until 1995. His main research interest is in the treatment of rectal cancers. He introduced contact X-ray brachytherapy (Papillon) into the UK and started treating patients at Clatterbridge from 1993. So far, his team has treated over 3000 patients using Papillon technique which is the world largest cohort of patients.

Arthur Sun Myint *1,2, Ngu Wah Than 1, 2, Muneeb Al Haq1,2, Helen Wong1, David Hughes2 and Mark D Pritchard2
1. Papillon Unit, Clatterbridge Cancer Centre, Liverpool, UK
2. Translation and Cancer Medicine department, University of Liverpool, UK
*Corresponding author Prof Arthur Sun Myint Lead Clinician (Papillon Unit Clatterbridge Centre for Cancer

Global Journal of Gastroenterology & Hepatology Research [GJGHR]
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Surgery is the standard of care for advanced rectal cancer. Usually, EBCRT with oral capecitabine if offered prior to sur-gery. Nearly half can achieved clinical complete response(cCR) and we could adopt ‘watch and wait’ strategy. About 25% of patients who achieved cCR will develop local regrowth needing salvage surgery and actual organ preservation rate is usually below 50%. Radiation dose escalation with Contact Xray bra-chytherapy (CXB) can improve organ preservation rates. We share our experience from randomised phase 3 trial OPERA (Organ Preservation in Early Rectal Adenocarcinoma) to eva-luate if non-surgical treatment with Watch and wait is possible for locally advanced rectal cancer.
From June 2015 to June 2020 148 patients with cT2cT3cN0/cN1 <5cm rectal cancer patients were randomised to either Arm A (Standard of Care) external beam chemo-radiotherapy [EBCRT] (45Gy/25#/5weeks) + capecitabine 825mg/m2 +EBRT boost(9Gy) or Arm B (experimental arm) EBCRT + CXB (90 Gy/3 #/4 weeks).
At median FU of 38.2 months, for patients with tumours of 3 cm or larger, 3-year organ preservation rates were 55% (95% CI 41–74) in group A versus 68% (54–85) in group B (HR 0•54, 95% CI 0•26–1•10; p=0•11). For patients with tumours less than 3 cm in diameter, 3-year organ preservation rates were 63% (95% CI 47–84) in group A versus 97% (91–100) in group B (HR 0•07, 95% CI 0•01–0•57; p=0•012).
Our data from randomised trial OPERA suggested that even for rectal tumour cT2/cT3 cN0/cN1 larger than 3 cm, organ preser-vation with watch and wait strategy is feasible and safe. Patients who are not fit for surgery or those who wish to avoid a stoma should be offered non-surgical treatment with EBCRT and CXB boost. Patients should be aware of this alternative treatment option.

Keywords:  advanced rectal cancer; non-surgical treatment; watch and wait; radiation dose escalation; Contact Xray Brachytherapy (CXB)

Digital Formats:  Any image file format that can be im-ported into this file will be acceptable for publication; to avoid technical problems, we suggest using PNG/JPEG format and mention Fig number with short detail. References: Use the brief numbered style common in many abstracts, e.g., [1], [2], etc. References should then appear in numerical order in the reference list, and should use the follow-ing abbreviated style:
[1] Arthur Sun Myint New hope from OPERA trial for surgically fit rectal cancer patients who wish to have organ preservation
(2022) Colorectal Disease https://DOI:10.1111/codi.16281
[2] A Sun Myint, A Dhadda, A Stewart Et al (2022) Clinical Oncology.35,(2):87-96
[3] Gerard JP, Barbet N, Schiappa R, Magne N, Martel I, Mi-neur L, et al. (2023)Neoadjuvant chemoradiotherapy with radiation dose escalation with contact x-ray brachytherapy boost or external beam radiotherapy boost for organ preservation in early cT2-cT3 rectal adenocarcinoma (OPERA): a phase 3, randomised controlled trial. Lancet Gastroenterol Hepatol; 8: 356-67

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