The Timing and Deferral of Rectal Surgery Following a Continued Complete Response to Pre-operative Chemoradiotherapy
There has been growing interest in selecting, pre-operatively, those rectal cancer patients who are likely to achieve pathological complete response (pCR) following pre-operative chemoradiotherapy. This is of particular importance for patients with low rectal cancers who would otherwise require an Abdomino-perineal resection and a permanent stoma.
In those patients with an optimal response on MRI, a ‘scar’ replaces the site of disease, rep-resented by a focal area of low-signal intensity on T2-weighted MR. The precise cellular composition of such an area of low signal intensity cannot be known, and a single MRI scan cannot diagnose complete response. However, if surgery is deferred, then the ‘scar’ may be monitored with serial imaging, clinical examination and CEA to exclude any change. By adopting this approach, the time interval to maximal tumour debulking can be established and identification of true ‘complete responders’ may be made (sustained radiological and clinical complete response for at least 1 year after CRT).
The Deferral of Surgery Trial is a single-centre interventional study. Patients follow a schedule of imaging, endoscopy and clinic appointments over a 10 year period. If a tumour re-grows, patients are quickly referred for surgery. The aim of the study is to show that the percentage of patients who can successfully avoid surgery is at least 10%.
The Deferral of Surgery trial is now closed to recruitment.
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