GS3 - Non-Operative Management in Young-Onset Patients with Rectal Adenocarcinoma: A Retrospective Cohort Study

Sunday, May 11, 2025

2:44 PM – 2:48 PM PT

Location: Ballroom 6B, Upper Level

Abstract Podium Presenter(s)

Roni Y. Rosen, MD

Research Fellow
Memorial Sloan Kettering Cancer Center
tenafly, New Jersey, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

Aron P. Bercz, MD (he/him/his)

Research Fellow/Resident
Memorial Sloan Kettering
Memorial Sloan Kettering Cancer Center
New York, New York, United States

Disclosure information not submitted.
WZ

Wini Zambare, MD

Research Fellow/Resident
Memorial Sloan Kettering Cancer Center
New York, New York, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
DO

Dana Omer, MD

Research Fellow
Memorial Sloan Kettering Cancer Center
New York, New York, United States

Disclosure information not submitted.
FV

Floris Verheij, MD PhD

Research Fellow
Memorial Sloan Kettering Cancer Center
New York, New York, United States

Disclosure information not submitted.
Garrett M. M. Nash, MD, MPH

Vice Chair of Quality and Safety
Memorial Sloan Kettering Cancer Center
New York, New York, United States

Disclosure information not submitted.
Philip B. B. Paty, MD

Attending Surgeon
Memorial Sloan Kettering Cancer Center
New York, New York, United States

Disclosure information not submitted.
Martin R. Weiser, MD

Vice Chair for Faculty Affairs
Memorial Sloan Kettering Cancer Center
Cornell Medical College
New York, New York, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
RM

Robin Mendelsohn, MD

Associate Physician
Memorial Sloan Kettering Cancer Center
New York, New York, United States

Disclosure information not submitted.
PR

Paul Romesser, MD

Attending
Memorial Sloan Kettering
New York, New York, United States

Disclosure information not submitted.
Andrea Cercek, MD

Associate Physician
Memorial Sloan Kettering Cancer Center
New York, New York, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Julio Garcia-Aguilar, MD, PhD (he/him/his)

Chief Attending
Memorial Sloan Kettering Cancer Center
Memorial Sloan Kettering Cancer Center
New York, New York, United States

Disclosure information not submitted.

Senior Author(s)

J. Joshua Smith, MD, PhD

Associate Attending
Memorial Sloan Kettering Cancer Center
MSKCC, Weill Cornell Medical College
New York, New York, United States

Disclosure information not submitted.

Submitting Author(s)

Roni Y. Rosen, MD

Research Fellow
Memorial Sloan Kettering Cancer Center
tenafly, New Jersey, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Roni Y. Rosen, MD: This individual has no financial relationships with ineligible companies.

Wini Zambare, MD: This individual has no financial relationships with ineligible companies.

Martin R. Weiser, MD: This individual has no financial relationships with ineligible companies.

Andrea Cercek, MD: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: The incidence of rectal adenocarcinoma is rising in patients < 50 years of age compared to those >50. Non-operative management and active surveillance has become a standard of care in rectal cancer treatment, however the outcomes and use of this approach in different age groups has not been well described. We explore the frequency of use and outcomes of non-operative management according to patient age.

Methods/Interventions: A retrospective review of a prospectively managed database identified patients with rectal adenocarcinoma who achieved a clinical complete response to neoadjuvant therapy and entered a watch-and-wait (WW) program (off-protocol) between January 2006-December 2020. The patients were divided into 3 groups according to age: young ( < 50), middle-aged (50-64) and elderly (>=65). Primary outcomes including local regrowth-free survival, disease-free survival and overall survival were assessed using Kaplan Meier analysis.

Results/Outcomes: A cohort of 1230 patients with rectal adenocarcinoma were identified, including 431 who were managed by WW. The patients were divided into 3 groups according to age: age < 50 (n=357), age 50-64 (n=499) and age 65 and older (n= 374). Twenty-seven percent (n=98) of patients were managed by WW vs. surgery in the < 50 group versus 33% (n=164) in the 50-64 and 45%(n=169) in the >65 group (p < 0.001). No differences were noted in the clinical stages (p=0.065) and tumor distance from the anal verge (p=0.345) amongst the groups. The 3-year local regrowth rates in each group were 23.8% (95%CI 15.2-32.4), 33.0% (95%CI 25.6-40.4) and 26.1% (95%CI 19.4-32.8) in the younger, middle-aged and elderly patients, respectively. The 5-year distant metastasis-free, disease-free and overall survival rates were not significantly different between the three age groups.

Conclusion/Discussion: While patients with early-onset rectal cancer have similar oncologic outcomes compared to those in older age groups when treated with nonoperative management, this approach is used less frequently in such patients. These data provide reassurance when offering a watch-and-wait approach to patients with young onset rectal cancer.