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Review
. 2017 Mar 23:3:9-15.
doi: 10.1016/j.ctro.2017.02.002. eCollection 2017 Apr.

Organ preservation in rectal cancer - Challenges and future strategies

C Gani  1   2 , P Bonomo  1   3 , K Zwirner  1 , C Schroeder  4 , A Menegakis  1 , C Rödel  5   6 , D Zips  1   2
Affiliations
Review

Organ preservation in rectal cancer - Challenges and future strategies

C Gani et al. Clin Transl Radiat Oncol. .

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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