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Comment & Response
June 27, 2019

Looking Forward, Not Backward, on Watch and Wait for Rectal Cancer—In Reply

Author Affiliations
  • 1Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
JAMA Oncol. 2019;5(8):1231. doi:10.1001/jamaoncol.2019.1887

In Reply We thank Dossa et al for their comments. Deficits in the literature for the watch-and-wait (WW) strategy after clinical complete response (cCR) include (1) lack of a true denominator encompassing the entire patient population treated with neoadjuvant chemoradiotherapy (CRT); (2) variable application and timing of diagnostic tools, including magnetic resonance imaging, physical examination, and endoscopy-defining cCR; and (3) no appropriate control group to provide context to oncologic outcome data. Prospective studies will provide more complete data; however, finding an optimal control group to precisely define the association between WW and patient survival and other oncologic outcomes is difficult. The optimal trial design of randomizing patients with cCR to WW vs radical resection will not be accepted by most patients and is thus impractical.