Organ preservation in rectal cancer - Challenges and future strategies

C Gani, P Bonomo, K Zwirner, C Schroeder, A Menegakis, C Rödel, D Zips, C Gani, P Bonomo, K Zwirner, C Schroeder, A Menegakis, C Rödel, D Zips

Abstract

Neoadjuvant radiochemotherapy with subsequent total mesorectal excision is the standard of care for locally advanced rectal cancer. While this multimodal strategy has decreased local recurrences rates below 5%, long-term morbidities are considerable in terms of urinary, sexual or bowel functioning. At the same time approximately 10-20% of patients have no evidence of residual tumour in their surgical specimen. Pioneering studies from Brazil have suggested that surgery can safely be omitted in carefully selected patients with a clinical complete response after radiochemotherapy. Although confirmatory studies showed similar results, challenges in terms of optimizing radiochemotherapy for organ-preservation, appropriate selection of patients for non-operative management and the safety of this approach remain. The present review will summarize the current data on organ-preservation in rectal cancer and discuss the challenges that need to be addressed in future trials.

Keywords: Chemoradiotherapy; Organ preservation; Radiochemotherapy; Radiotherapy; Rectal cancer; Wait and see.

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