Current Imaging and Biomarker Barriers to a Selective Therapy Approach for Rectal Cancer

摘要

The standard treatment for patients with locally advanced rectal cancer includes neoadjuvant chemora-diation therapy (CRT) followed by rectal resection. With this approach, between 10% and 30% of patients have no demonstrable residual disease, referred to as a pathologic complete response (pCR), in the resected specimen. Following neoadjuvant CRT and resection, patients with a pCR have significantly better outcomes than those patients whose rectal cancers are not downstaged. This suggests that in a subset of patients who achieve a pCR, definitive local control could potentially be achieved through a non-operative management alone. In fact, patients who experience a clinical complete response following neoadjuvant CRT and are followed with a non-operative approach appear to have acceptable rates of recurrence and survival.