Est-il raisonnable de proposer un traitement local apres radiochimiotherapie neoadjuvante ? Question 4: Is it reasonnable to perform a local excision after neoadjuvant chemoradiotherapy?

摘要

Rectal exerese is the standard in rectal cancer treatment. The morbidity of rectal exerese, together with the low rate of positive lymph nodes in patients with a good response after radiochemotherapy, raises the challenging concept of organ preservation. Patients with a complete response can benefit from a nonoperative strategy based on a strict follow up. Those with a complete or subcomplete response can be treated by local exerese. Limitations in accurately assessing a complete response by conventional and modern imaging modalities suggest that local exerese is more appropriate for the majority of patients when organ preservation is being considered. The encouraging results of retrospective series of local exerese in downstaged clinical T2/T3 low rectal cancer after radiochemotherapy, however, need to be confirmed by the ongoing multicentre trials before routinely proposing organ preservation in patients with a good response.