Complete clinical response to neoadjuvant chemoradiotherapy in patients with rectal cancer: opinions of British and Irish specialists

Abstract

No consensus exists as to what defines a complete response and at present there is resistance to offering nonoperative management in selected patients. With improvements in neoadjuvant treatment modalities, it will be increasingly important to consider nonoperative management in the future.

Accuracy of transrectal ultrasound after preoperative radiochemotherapy compared to computed tomography and magnetic resonance in locally advanced rectal cancer

“…On the other hand, it has to be considered that complication rate after surgery is significantly higher in patients who underwent neoadjuvant therapy [10,11], and that it is common opinion that despite the result of neoadjuvant therapy, except in carefully selected cases, the surgical treatment programmed before treatment should not be changed [12,13]. This is a controversial topic, which raises the concern if in patients in whom radiation therapy with concomitant chemotherapy has led to downstaging of tumors to lesions confined to the rectal wall (T0-2 tumors) and in whom there are no longer involved lymph nodes (N0 lesion), local transanal full thickness excision of the bowel wall may be all that is required to cure the patient or exposes the patient to an undue risk of recurrence.…”

Synchronous Locally Advanced Rectal Cancer with Clinical Complete Remission and Important Downstaging after Neoadjuvant Radiochemotherapy - Personalised Therapeutic Approach

“…Currently, it seems that there is no widespread consensus amongst colorectal surgeons as to the definition of a cCR (25).…”

“…In literature, varying approaches, like transanal endoscopic microsurgery and even "wait and see", are described for patients with good response after chemoradiation. However, it seems that there is no widespread consensus amongst colorectal surgeons regarding the definition of a complete clinical remission (cCR) (5), and therapeutic approaches that exclude surgery are not sustained by randomised clinical trials.…”

Paradigm Shift in the Management of Rectal Cancer

“…At present, subsequent surgical resection remains the standard of care even if a complete response is suspected. The rational for this is concern that there may be undetected microscopic disease or that the disease will recur [37]. There has however been interest in the work of HabrGama and colleagues who have reported their experience of observation rather than resection in patients who have a complete response [38].…”