Road to organ preservation in locally advanced rectal cancer

Abstract

Introduction. In the past 20 years there has been significant change in the treatment of rectal cancer, especially in terms of multimodal approach. Surgery is, at least for now, the mainstay treatment for resectable rectal cancer. Preoperative chemoradiotherapy is, regardless of its modality, short or long course, different chemotherapeutic regiments, widely recommended for locally advanced rectal cancer. After neoadjuvant treatment, 15–27% of patients experience pathological complete response (pCR). These patients could benefit from non-operative management, thus avoiding potential surgical complications and possible reduction in the quality of life. Unfortunately, one cannot precisely define, while omitting surgery, which patients have pCR. For this reason Habr-Gama, a pioneer in the “watch-and-wait” strategy, developed a new endpoint for non-operative management – clinical complete response. To measure the response, in the absence of pathological examination, same diagnostic tools are used as in initial staging, but none is reliable enough to be used alone. This article is focusing on critical points in the reassessment of response to preoperative chemoradiotherapy for advanced rectal cancer, which is mandatory for appropriate selection of patients who might benefit from non-operative management.

Keywords

• rectal cancer
• organ preservation
• non-operative management
• chemoradiation therapy
• total neoadjuvant therapy
• clinical complete response
• pathologic complete response