Assessment of Clinical Complete Response After Chemoradiation for Rectal Cancer with Digital Rectal Examination, Endoscopy, and MRI

Excerpt

Over the past 30 years, multimodal therapy has emerged as the treatment of choice for rectal cancer. Standard management includes neoadjuvant chemoradiation with capecitabine or 5-fluorouracil and total mesorectal excision (TME), with adjuvant chemotherapy, including a fluoropyrimidine and oxaliplatin. A recent trend has emerged in which adjuvant chemotherapy is delivered as an induction before chemoradiation.1‐3 In spite of achieving impressive local control, this trimodal therapy is arduous, and many patients do not complete it, especially when chemotherapy is planned for postoperative administration. It is associated with short-term toxicity and long-term complications, and accompanied by significant alterations in quality of life. Strategies are emerging to lessen the intensity of treatment by either modifying the treatment schedule or removing either radiotherapy or surgery, thereby reducing morbidity and deleterious changes in patients’ quality of life while maintaining or even improving oncologic outcomes. …