Wu A W
Department of Gastrointestinal Cancer, Unit Ⅲ, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Bejing 100142, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2020 Mar 25;23(3):225-229. doi: 10.3760/cma.j.cn.441530-20200224-00076.
The comprehensive treatment of solid tumor has become a mature treatment model. Under this model, many tumors, such as breast cancer, anal squamous cell carcinoma, rectal gastrointestinal stromal tumor and rectal cancer, are undergoing the evolutionary process of reducing the extent of surgery and witnessing an increasing demand for organ preservation. Watch and wait (W&W) after neoadjuvant chemoradiation therapy (nCRT) for rectal cancer is a hot topic in recent years. Available data suggest that patients with clinical or expected pathologic complete remission who adopt a W&W strategy are more likely to achieve an outcome similar to surgery, but with a significant improvement in quality of life. From the perspective of the evolution of surgical oncology, it is necessary to conduct further researches on patient screening, strategy improvement, evaluation optimization, and risk control during implementation. Encouraging doctor-patient shared decision-making, adequate patient communication and informed consent, careful design and practice of clinical research, and accumulation of high-level evidence are crucial to this effort. The concept of "intentional W&W" will help to promote the researches, and we should also be alert to the challenges and risks in the implementation process.
实体肿瘤的综合治疗已成为一种成熟的治疗模式。在这种模式下，许多肿瘤，如乳腺癌、肛管鳞状细胞癌、直肠胃肠道间质瘤和直肠癌，正经历着手术范围缩小的演变过程，并且对器官保留的需求日益增加。直肠癌新辅助放化疗（nCRT）后的观察等待（W&W）是近年来的一个热门话题。现有数据表明，采用观察等待策略的临床或预期病理完全缓解的患者更有可能获得与手术相似的结果，但生活质量有显著改善。从外科肿瘤学的发展角度来看，有必要在实施过程中对患者筛选、策略改进、评估优化和风险控制进行进一步研究。鼓励医患共同决策、充分的患者沟通和知情同意、精心设计和开展临床研究以及积累高级别证据对这项工作至关重要。“有意观察等待”的概念将有助于推动相关研究，同时我们也应警惕实施过程中的挑战和风险。
