doiSerbia

Evolving paradigms in locally advanced rectal cancer: Review of the non-operative approach and future directions

Polcz Monica E. (Florida International University, Herbert Wertheim College of Medicine, Miami, USA)
Smith Jesse Joshua (Memorial Sloan Kettering Cancer Center, Department of Surgery, New York, USA)
Paty Philip B. (Memorial Sloan Kettering Cancer Center, Department of Surgery, New York, USA)

The standard treatment of locally advanced rectal cancer in the United States is neoadjuvant chemoradiation, surgical resection with total mesorectal excision, and adjuvant chemotherapy. In recent years, a non-operative approach has been suggested for patients achieving a complete clinical response with chemoradiation alone to avoid the morbidity that accompanies radical excision. This approach is justified by the observation that a significant proportion of patients (15-40%) have achieved a pathological complete response by the time of surgery. We review the most recent literature to determine if the oncologic outcomes are comparable. We also discuss future directions in management, including the consolidation of chemotherapy with neoadjuvant chemoradiation. Currently, distant recurrence rates exceed those of local recurrence and adjuvant chemotherapy is often delayed pending post-operative recovery. Offering chemotherapy up-front would simultaneously treat both the primary tumor and any micrometastatic disease without delay. A trial is currently underway at our center evaluating these treatment modalities.

Keywords: Rectal cancer, Non-operative management, Locally advanced rectal cancer