Disease-Free Probability at Any Time After Total Neoadjuvant Therapy (Chemotherapy and Radiation) for Rectal Cancer Treated with Surgery or Watch-and-Wait

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This clinical calculator is a tool designed to predict the likelihood of surviving free of rectal cancer five years after undergoing total neoadjuvant therapy (treatment that combines chemotherapy and radiotherapy) with watch and wait, immediate or delayed surgery. The tool is appropriate for patients whose rectal cancer has shown no evidence of distant metastasis or spread to other organs beyond the rectum or regional lymph nodes before total neoadjuvant therapy or at the time of total neoadjuvant therapy.

Results produced by this tool are based on data from patients treated at large research institutions with physicians who perform a high volume of rectal cancer procedures. All results must be understood in the context of each patient’s specific treatment plan. Patients and caregivers using this tool should discuss the result with the patient’s physician.

To gather the information required to use this clinical calculator, use our worksheet.

Enter Your Information

All fields are required unless noted optional
Note: Please enter either the date of last chemotherapy or date of last radiation therapy (whichever is later). This calculator is only appropriate for you if it has been 3 months (90 days) or longer since you completed all chemotherapy and radiation therapy (total neoadjuvant treatment).
months
Did you have surgery to remove the rectum and tumor?
Are you on watch-and-wait management (non-surgical management) for your rectal cancer?
Note: This calculator is only appropriate for you if it has been 3 months (90 days) or longer since you completed all chemotherapy and radiation therapy (total neoadjuvant therapy). This calculator is not appropriate for you if you are not on watch-and-wait management.
Was the tumor distance from the anal verge greater than 5 cm?
Note: This information can be found in the colonoscopy, proctoscopy, or MRI report. The surgeon may also note this in the office visit or operative note.
What is the anal verge?
The anal verge refers to where the anal canal connects to the outside skin at the anus.
Note: T stage is determined by pathology (not clinical T stage determined by radiology), sometimes denoted as ypT2, etc. This prediction tool is only applicable for T stages T1 to T4. Indicating the substage by letter (e.g., a or b) is not required.
More on T Staging
The T stages are part of the TNM Staging System, which uses TNM classifications to describe the extent of cancer in a patient's body. T describes how deep the tumor has invaded into the colon wall; N describes whether regional lymph nodes are involved and, if so, how extensively; and M describes whether distant metastasis (spread of cancer from one body part to another) is present. The system is maintained by the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC) and is updated periodically.
(0 to 24+)
Note: This information can be found in the pathology report.
Was cancer present in or around the nerves?
Note: This information can be found in the pathology report.
What is perineural invasion?
Perineural invasion means that cancer cells were found in or around the nerves near the rectum.
Was cancer present in the blood vessels?
Note: This information can be found in the pathology report.
What is venous invasion?
Venous invasion means that cancer cells were found in the vessels of the rectum.
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Supporting Publications

Probability of Remaining Disease-Free After Total Neoadjuvant Therapy for Rectal Cancer and Either Surgery or Watch-and-Wait

Probability of remaining free of rectal cancer at five years after total neoadjuvant therapy (combining chemotherapy and radiotherapy) with either immediate surgery or watch-and-wait with the possibility of delayed surgery

Weiser MR, Chou JF, Kim JK, Widmar M, Wei IH, Pappou EP, Smith JJ, Nash GM, Paty PB, Cercek A, Saltz LB, Romesser PB, Crane CH, Garcia-Aguilar J, Schrag D, Gönen M. A Dynamic Clinical Calculator for Estimating Conditional Recurrence-Free Survival After Total Neoadjuvant Therapy for Rectal Cancer and Either Surgery or Watch-and-Wait Management. JAMA Netw Open. 2022 Sep 1;5(9):e2233859. doi: 10.1001/jamanetworkopen.2022.33859. PMID: 36173634; PMCID: PMC9523500.