Nonoperative management of rectal cancer. Issue 1 (24th November 2015) - Torok, Jordan A.
Abstract : Surgery has long been the primary curative modality for localized rectal cancer. Neoadjuvant chemoradiation has significantly improved local control rates and, in a significant minority, eradicated all disease. Patients who achieve a pathologic complete response to neoadjuvant therapy have an excellent prognosis, although the combination treatment is associated with long‐term morbidity. Because of this, a nonoperative management (NOM) strategy has been pursued to preserve sphincter function in select patients. Clinical and radiographic findings are used to identify patients achieving a clinical complete response to chemoradiation, and they are then followed with intensive surveillance. Incomplete, nonresponding and those demonstrating local progression are referred for salvage with standard surgery. Habr‐Gama and colleagues have published extensively on this treatment strategy and have laid the groundwork for this approach. This watch‐and‐wait strategy has evolved over time, and several groups have now reported their results, including recent prospective experiences. Although initial results appear promising, several significant challenges remain for NOM of rectal cancer. Further study is warranted before routine implementation in the clinic. Cancer 2016;122:34–41. © 2015 American Cancer Society . Abstract : Nonoperative management of rectal cancer is under active investigation on the basis of results from several promising institutional series. Challenges and uncertainties remain and limit the routine use of this strategy in the clinic.