Inclusion Criteria for the “Watch and Wait” Protocol in Rectal Cancer and its Importance in Adherence to Follow-up

The “Watch and Wait” protocol has become an important strategy in the treatment of locally advanced rectal cancer. This approach involves carefully monitoring patients who have responded favorably to neoadjuvant treatment (radiotherapy and chemotherapy), without the need for immediate surgery, with the goal of preserving anal sphincter function and avoiding colostomy.

The inclusion criteria for applying the “Watch and Wait” protocol are specific and must be accurately assessed to ensure the patient is suitable for this approach. The most important criteria include:

1. Complete clinical response: This refers to the complete disappearance of the tumor in initial evaluations after neoadjuvant treatment. It must be verified through magnetic resonance imaging (MRI) and rectoscopy.
2. Localized tumors: The cancer must be confined to the rectum without involvement of nearby lymph nodes or other organs. There should be no evidence of metastasis.
3. General health status of the patient: The patient must be in good overall health to undergo intensive follow-up without the need for immediate surgery.

The implementation of the “Watch and Wait” protocol requires very close and regular follow-up. The importance of adherence to follow-up is crucial to ensure that any signs of recurrence are detected in a timely manner, allowing for the initiation of additional treatment if necessary. The follow-up during the first two years must be rigorous and carried out with the highest possible frequency.

During this period, it is recommended that patients undergo MRI every 3-6 months to monitor any changes in the tumor or signs of recurrence. Additionally, rectoscopy should be performed every 3-6 months during the first two years. This allows for a direct evaluation of the rectum and the early detection of any possible recurrences in the area of the primary tumor.

Dr. Rolando Loría Ruiz, a Radiation Oncologist in Costa Rica, is an expert in managing advanced treatment protocols such as “Watch and Wait”. On his website www.drrolandoloria.com, Dr. Loría provides detailed information about treatment options and follow-up care for patients with rectal cancer.

Constant vigilance and proper follow-up are essential to maximize outcomes in the management of rectal cancer, promoting quality of life preservation and reducing the need for invasive surgical interventions.