The Selective Use of Radiation Therapy in Rectal Cancer Patients
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Purpose of Review
Colorectal cancer has a high global incidence, and standard treatment employs a multimodality approach. In addition to cure, minimizing treatment-related toxicity and improving the therapeutic ratio is a common goal. The following article addresses the potential of omitting radiotherapy in select rectal cancer patients.
Omission of radiotherapy in rectal cancer is analyzed in the context of historical findings, as well as more recent data describing risk stratification of stage II–III disease, surgical optimization, imaging limitations, improvement in systemic chemotherapeutic agents, and contemporary studies evaluating selective omission of radiotherapy.
A subset of rectal cancer patients exists that may be considered low to intermediate risk for locoregional recurrence. With appropriate staging, surgical technique, and possibly improved systemic therapy, it may be feasible to selectively omit radiotherapy in these patients. Current imaging limitations as well as evidence of increased locoregional recurrence following radiotherapy omission lend us to continue supporting the standard treatment of approach of neoadjuvant chemoradiation therapy followed by surgical resection until additional improvements and prospective evidence can support otherwise.
KeywordsRadiotherapy omission Rectal cancer Risk stratification rectal cancer Imaging rectal cancer Minimizing toxicity Prognostic factors rectal cancer
Compliance with Ethical Standards
Conflict of Interest
Andrew Martella declares that he has no conflict of interest.
Christopher Willett declares that he has no conflict of interest.
Manisha Palta has received research support from Merck and honoraria from Oakstone CME and UpToDate.
Brian Czito declares that he has no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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