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Review
. 2022 Jun 30;14(13):3204.
doi: 10.3390/cancers14133204.

Non-Operative Management of Patients with Rectal Cancer: Lessons Learnt from the OPRA Trial

Paolo Goffredo  1 , Felipe F Quezada-Diaz  2 , Julio Garcia-Aguilar  1 , J Joshua Smith  1
Affiliations
Review

Non-Operative Management of Patients with Rectal Cancer: Lessons Learnt from the OPRA Trial

Paolo Goffredo et al. Cancers (Basel). .

Abstract

Over the past decade, the management of locally advanced rectal cancer (LARC) has progressively become more complex. The introduction of total neoadjuvant treatment (TNT) has increased the rates of both clinical and pathological complete response, resulting in excellent long-term oncological outcomes. As a result, non-operative management (NOM) of LARC patients with a clinical complete response (cCR) after neoadjuvant therapy has gained acceptance as a potential treatment option in selected cases. NOM is based on replacement of surgical resection with safe and active surveillance. However, the identification of appropriate candidates for a NOM strategy without compromising oncologic safety is currently challenging due to the lack of an objective standardization. NOM should be part of the treatment plan discussion with LARC patients, considering the increasing rates of cCR, patient preference, quality of life, expectations, and the potential avoidance of surgical morbidity. The recently published OPRA trial showed that organ preservation is achievable in half of rectal cancer patients treated with TNT, and that chemoradiotherapy followed by consolidation chemotherapy may an appropriate strategy to maximize cCR rates. Ongoing trials are investigating optimal algorithms of TNT delivery to further expand the pool of patients who may benefit from NOM of LARC.

Keywords: chemoradiation; neoadjuvant therapy; nonoperative management; rectal cancer; total neoadjuvant therapy; watch and wait.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Memorial Sloan Kettering three-tiered response/regression schema.
See this image and copyright information in PMC

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