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Is It Really Gone? Assessing Response to Neoadjuvant Therapy in Rectal Cancer

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Abstract

Purpose

Non-operative management of rectal cancer is a feasible and appealing treatment option for patients who develop a complete response after neoadjuvant therapy. However, identifying patients who are complete responders is often a challenge. This review aims to present and discuss current evidence and recommendations regarding the assessment of treatment response in rectal cancer.

Methods

A review of the current literature on rectal cancer restaging was performed. Studies included in this review explored the optimal interval between the end of neoadjuvant therapy and restaging, as well as modalities of assessment and their diagnostic performance.

Results

The current standard for restaging rectal cancer is a multimodal assessment with the digital rectal examination, endoscopy, and T2-weighted MRI with diffusion-weighted imaging. Other diagnostic procedures under investigation are PET/MRI, radiomics, confocal laser endomicroscopy, artificial intelligence-assisted endoscopy, cell-free DNA, and prediction models incorporating one or more of the above-mentioned exams.

Conclusion

Non-operative management of rectal cancer requires a multidisciplinary approach. Understanding of the robustness and limitations of each exam is critical to inform patient selection for that treatment strategy.

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Authors and Affiliations

  1. Department of Surgery, Division of General Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, H3680K94305, USA

    Cintia Kimura, Sarah Elizabeth Crowder & Cindy Kin

  2. Brigham Young University, Provo, UT, USA

    Sarah Elizabeth Crowder

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Conceptualization: Cindy Kin. Literature search: Cintia Kimura and Eliza Crowder. Analysis, writing, critical revisions: Cindy Kin, Cintia Kimura, and Eliza Crowder. Figures and Tables: Cindy Kin.

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Kimura, C., Crowder, S.E. & Kin, C. Is It Really Gone? Assessing Response to Neoadjuvant Therapy in Rectal Cancer. J Gastrointest Canc 54, 703–711 (2023). https://doi.org/10.1007/s12029-022-00889-x

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