Non-operative management of locally advanced rectal cancer

A combination of chemoradiation therapy (CRT) and total mesorectal excision (TME) provides excellent locoregional control in locally advanced rectal cancer; however, this regimen may be associated with significant morbidity. Researchers have assessed the safety of omitting rectal resection in patients who achieve a clinical complete response to CRT. Preliminary results have been promising. However, the accurate identification of patients who have responded completely to CRT is a challenge to non-operative management. Other areas warranting further investigation include techniques to increase response rates and to identify upfront those patients who are most likely to respond to CRT.