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Toward the Non-surgical Management of Locally Advanced Rectal Cancer

  • Gastrointestinal Cancers (L Saltz, Section Editor)
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Abstract

Neoadjuvant short-course radiotherapy and long-course chemoradiation (CRT) reduce local recurrence rates when compared to surgery alone and remain widely accepted as standard of care for patients with locally advanced rectal cancer. However, surgery is not without complications and a non-surgical approach in carefully selected patients warrants evaluation. A pathological complete response to CRT is associated with a significant improvement in survival and it has been suggested that a longer time interval between the completion of CRT and surgery increases tumor downstaging. Intensification of neoadjuvant treatment regimens to increase tumor downstaging has been evaluated in a number of clinical trials and more recently the introduction of neoadjuvant chemotherapy prior to CRT has demonstrated high rates of radiological tumor regression. Careful selection of patients using high-resolution MRI may allow a non-surgical approach in a subgroup of patients achieving a complete response to neoadjuvant therapies after an adequate time period. Clearly this needs prospective evaluation within a clinical trial setting, incorporating modern imaging techniques, and tissue biomarkers to allow accurate prediction and assessment of response.

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Acknowledgments

The authors acknowledge NHS funding from the NIHR Biomedical Research Center and the Peter Stebbings Memorial Charity.

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  1. GI & Lymphoma Research Unit, Royal Marsden Hospital, London and Surrey, UK

    Alice Dewdney & David Cunningham

  2. Department of Medicine, Royal Marsden Hospital, Downs Road, Sutton, Surrey, SM2 5PT, UK

    David Cunningham

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  1. Alice Dewdney
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Correspondence to David Cunningham.

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Dewdney, A., Cunningham, D. Toward the Non-surgical Management of Locally Advanced Rectal Cancer. Curr Oncol Rep 14, 267–276 (2012). https://doi.org/10.1007/s11912-012-0234-z

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