title: Predicting complete response: is there a role for non-operative management of rectal cancer?
abstract: Pre-operative chemoradiotherapy followed by a total mesorectal excision (TME) is the standard of care for patients with locally advanced (stage II or III) rectal cancer. Approximately 20% of patients may achieve a pathologic complete response after chemoradiation therapy (CRT), which has been shown to be associated with better oncologic outcomes. Whether surgery can be avoided in this population is an area of active investigation. Recent studies demonstrated feasibility and safety of non-operative management in patients with clinical complete response (cCR) after chemoradiotherapy. In this article, we set out to review the current data on non-operative management and to identify areas requiring further investigation, including improvement in imaging for reassessment after CRT and identifying the optimal time frame for restaging. As the field moves forward with non-operative management in select patients with rectal cancer, there continues to be a need to better understand the prognostic factors and biomarkers that may more accurately characterize patients who are qualified for this "wait-and-see" approach and thereby avoid overtreatment, potentially leading to improvements in long-term quality of life.
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
authors.forename: T Jonathan
authors.initials: TJ
authors.lastname: Yang
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
authors.forename: Karyn A
authors.initials: KA
authors.lastname: Goodman
keywords: Rectal cancer; chemoradiation therapy (CRT); non-operative management
references.citation: Eur Radiol. 2012 Apr;22(4):821-31
references.pmid: 22101743
references.citation: J Clin Oncol. 2009 Nov 1;27(31):5124-30
references.pmid: 19770376
references.citation: Ann Surg. 2016 Mar;263(3):458-64
references.pmid: 24263329
references.citation: Dis Colon Rectum. 2011 Sep;54(9):1141-6
references.pmid: 21825895
references.citation: J Gastrointest Surg. 2006 Dec;10(10):1319-28; discussion 1328-9
references.pmid: 17175450
references.citation: J Gastrointest Surg. 2005 Jan;9(1):90-9; discussion 99-101
references.pmid: 15623449
references.citation: Int J Radiat Oncol Biol Phys. 2008 Jul 15;71(4):1181-8
references.pmid: 18234443
references.citation: Colorectal Dis. 2006 Sep;8 Suppl 3:21-4
references.pmid: 16813588
references.citation: Radiology. 2013 Oct;269(1):101-12
references.pmid: 23801777
references.citation: J Clin Oncol. 2005 May 20;23(15):3475-9
references.pmid: 15908656
references.citation: Ann Surg Oncol. 2008 Mar;15(3):712-20
references.pmid: 18163173
references.citation: Ann Surg Oncol. 2007 Feb;14(2):455-61
references.pmid: 17139456
references.citation: Semin Radiat Oncol. 2011 Jul;21(3):234-9
references.pmid: 21645869
references.citation: Ann Surg. 2011 Jul;254(1):97-102
references.pmid: 21494121
references.citation: Dis Colon Rectum. 2013 Oct;56(10):1109-17
references.pmid: 24022527
references.citation: Int J Radiat Oncol Biol Phys. 2000 Jan 15;46(2):313-22
references.pmid: 10661337
references.citation: Ann Surg. 2013 Aug;258(2):289-95
references.pmid: 23187748
references.citation: J Natl Compr Canc Netw. 2014 Apr;12(4):513-9
references.pmid: 24717570
references.citation: N Engl J Med. 2004 Oct 21;351(17):1731-40
references.pmid: 15496622
references.citation: Ann Surg. 2012 Dec;256(6):965-72
references.pmid: 23154394
references.citation: Dis Colon Rectum. 2009 Dec;52(12):1927-34
references.pmid: 19934911
references.citation: Lancet Oncol. 2010 Sep;11(9):835-44
references.pmid: 20692872
references.citation: J Clin Oncol. 2011 Dec 10;29(35):4633-40
references.pmid: 22067400
references.citation: Ann Surg. 2011 Mar;253(3):539-45
references.pmid: 21239980
references.citation: Eur Radiol. 2013 Jan;23(1):253-61
references.pmid: 22777621
references.citation: Ann Surg. 2004 Oct;240(4):711-7; discussion 717-8
references.pmid: 15383798
references.citation: Ann Surg Oncol. 1999 Jul-Aug;6(5):433-41
references.pmid: 10458680
references.citation: Ann Surg Oncol. 2012 Feb;19(2):384-91
references.pmid: 21755378