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Can We Reliably Predict a Clinical Complete Response in Rectal Cancer? Current Trends and Future Strategies

  • Surgery and Surgical Innovations in Colorectal Cancer (S Huerta, Section Editor)
  • Published:
Current Colorectal Cancer Reports

Abstract

Purpose of Review

Prediction of clinical complete response is pivotal in the management of patients with rectal cancer. The ability to determine tumor response to neoadjuvant therapy in rectal cancer might guide subsequent treatment modalities. We review the current literature on predictors of complete response after neoadjuvant for rectal cancer with an emphasis of clinical complete response rather than pathological complete response.

Recent Findings

Clinical and radiological findings have been used to predict response, as well as a myriad of biomarkers. There is limited evidence validating most of these strategies. The role of imaging in defining tumor response has been assessed retrospectively. The TRIGGER trial is a randomized trial that will evaluate stratified management of rectal cancer based on their tumor regression grade.

Summary

The management of locally advanced rectal cancer is evolving. The ability to predict clinical complete response in patients that have undergone neoadjuvant chemoradiation will allow us to select potential patients that can benefit from a “watch and wait” strategy. Identifying patients that will have a complete response will result in decreased surgical overtreatment, favoring organ-sparing strategies. Treatment individualization will require further research. Emphasis should be made in validating prediction markers; these should be cost-effective and of minimally invasive retrieval. Surveillance protocols to assess for tumor regrowth are yet to be determined.

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Abbreviations

cCR:

Clinical complete response

pCR:

Pathologic clinical response

TME:

Total mesorectal excision

mrTGR:

Magnetic resonance tumor-grade regression

CRT:

Chemoradiation

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9159, USA

    Luis R. Taveras, Holly B. Cunningham & Jonathan B. Imran

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  1. Luis R. Taveras
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  2. Holly B. Cunningham
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Correspondence to Luis R. Taveras.

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This article is part of the Topical Collection on Surgery and Surgical Innovations in Colorectal Cancer

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Taveras, L.R., Cunningham, H.B. & Imran, J.B. Can We Reliably Predict a Clinical Complete Response in Rectal Cancer? Current Trends and Future Strategies. Curr Colorectal Cancer Rep 14, 56–63 (2018). https://doi.org/10.1007/s11888-018-0401-1

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