Hi All,
After 18 months on a watch and wait program I just want to think out loud a bit and put down what I feel is the biggest question when deciding whether watch and wait is the best way forward after a radiologically complete response.
If someone has a radiologically complete response, goes on watch and wait and is long term cancer free, then everyone would agree that would be a terrific result as you have got rid of the cancer long term without surgery.
If someone has a radiologically complete response and then the cancer comes back locally in the rectum and is removed by surgery and then afterwards the cancer doesn't spread then the patient wasn't harmed by the wait.
However its a bit more tricky if someone is put on watch and wait, the cancer comes back locally in the rectum and then goes on to spread to distant organs.
Has this happened because the metastasis has been seeded from the regrowth of the tumour locally in the rectum and that this would not have happened if surgery had been done immediately after radiotherapy. In this case watch and wait has harmed the patient.
Alternatively, it may be that the metastasis would have happened anyway regardless of whether there was surgery straight after radiotherapy or after a regrowth with watch and wait. In this case watch and wait has not harmed the patient.
I think that to answer this question properly they would need to take a cohort of patients who have had a radiologically complete response and randomly assign some to have surgery and others to watch and wait and compare outcomes especially as regards metastasis.
But they can't ethically do this because most patients don't want to be randomly assigned to surgery which is why we don't really know. See the video below.
I was told by my NHS surgeon that surgery would not improve my survival chances compared with watch and wait so I opted for watch and wait. However please see this video by Dr Philip Paty https://www.youtube.com/watch?v=8WqV-kqSQ5E where he presents a somewhat more uncertain picture about whether it is possible that the wait might possibly harm a patient or not.
It's a difficult decision about whether to choose watch and wait after a radiologically complete response. I think this question is at the heart of it.
Hi
I’ve tagged Jogey for you. Then that’ll notify them. You can private message as well if you want. Click on their name then you can read their bio or message
Best wishes
Ann
You too Jeri
Weathers great in the south. Hope yours is good too
Ann
